Analysis of Mortality in Patients with Acute Myocardial Infarction after Revascularization

Annotation. The objective of the study was to conduct a comparative analysis of the clinical and functional characteristics of the course of acute myocardial infarction (STEMI) after revascularization in patients who died and those who survived. The study included 286 patients with an average age of 62.8±9.8 years. Among the participants, 202 (70.6%) were men and 84 (29.4%) were women. All patients were hospitalized within 12 hours from the onset of pain syndrome, and all underwent urgent coronary angiography and stenting of the infarct-related artery. All patients underwent a general clinical examination, laboratory diagnostics including the determination of hemoglobin, glucose, creatinine, cystatin C, troponin I, C-reactive peptide; coronaroventriculography, 12-lead electrocardiography, and echocardiography according to the standard protocol. Statistical analysis of the obtained results was performed using the STATISTICA 6.1 software package, version No. ВХХR901E246022FA, and Microsoft Excel. It was found that 28 individuals (9.8%) died during the hospitalization stage. The average age of the deceased was 62.5 (55.5; 70.5) years, which does not significantly differ from that of the surviving patients. There was no statistical difference in gender characteristics either, with 21 (75.0%) men among the deceased and 181 (70.2%) men among the survivors, p=0.59. In the group of deceased patients, there was a significantly higher number of individuals with multivessel coronary artery disease, specifically 13 (46.4%) compared to 74 (28.7%), p=0.005. Among the surviving patients, there was a significantly higher number of individuals with single-vessel disease: 6 (21.4%) compared to 102 (39.5%), p=0.06. Among the deceased patients, acute heart failure Killip IV, p=0.009, and conduction disorders, p=0.01, were significantly more frequently diagnosed. In the group of deceased individuals, the levels of C-reactive peptide were significantly higher at 13.2 (5.5; 19.5) compared to 10.0 (6.0; 16.0), p=0.05; cystatin C levels were 1.61 (0.98; 1.51) compared to 1.23 (0.97; 1.38), p=0.05; and glucose levels were 8.8 (5.8; 12.1) compared to 7.1 (5.9; 10.0), p=0.05. So, among patients with STEMI, 28 individuals (9.8%) died during the hospital stage after urgent revascularization. Among the deceased patients, acute heart failure Killip IV and conduction disorders (sinoatrial and atrioventricular block) were significantly more frequently diagnosed, which became the cause of death. One of the most clinically and statistically significant factors distinguishing the comparison groups was the predominance of patients with multivessel disease. In the group of patients who died in the hospital, significantly higher levels of CRP, cystatin C, and glucose were noted. The level of cystatin C is a more sensitive diagnostic criterion in deceased patients compared to creatinine.