Hospital Mortality and Complications of Myocardial Infarction in Patients Aged 75 Years and Older with Myocardial Infarction with and without ST Segment Elevation Electrocardiograms

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Abstract

Background. Currently, data on hospital mortality and the frequency of complications of myocardial infarction in patients aged 75 and older with myocardial infarction with ST-segment elevation (STEMI) and without ST-segment elevation (NSTEMI) are inconclusive. New carefully planned retrospective and prospective studies are needed to clarify them.

Aims — to compare hospital mortality and the frequency of myocardial infarction complications among patients admitted to a cardiology ward with the possibility of percutaneous coronary intervention, with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) in patients ≥ 75 years of age.

Methods. A retrospective analysis of medical records of 437 consecutively enrolled patients aged ≥ 75 years, hospitalized in a cardiology department due to myocardial infarction during 2020–2021, was conducted. This section of the study included patients with STEMI (174 patients) and NSTEMI (119 patients). Considering the presence of statistically significant differences between the compared groups (STEMI and NSTEMI) based on clinical and anamnestic data, pseudo-randomization was performed using propensity score matching (PSM) based on all studied clinical and anamnestic data and the administered treatment, resulting in two groups of 78 patients each.

Results. The frequency of myocardial infarction complications differed between patients with STEMI and NSTEMI before PSM. Atrial fibrillation occurred significantly more often in patients with STEMI compared to those with NSTEMI: in 26.4 and 16.0% of cases, respectively (p = 0.034). Atrioventricular blocks of 2–3rd degree complicated the course of myocardial infarction in 14.4% of patients with STEMI and 5.0% of those with NSTEMI (p = 0.011). After PSM, the frequency of all developed complications among patients with STEMI and NSTEMI didn`t show statistically significant differences. The incidence of deaths before PSM didn`t differ statistically significantly. After PSM, the death rate also remained comparable: at STEMI 28.2% and at NSTEMI 15.4% (p = 0.131).

Conclusions. This study demonstrated no statistically significant difference in hospital mortality rates and the development of myocardial infarction complications in comparable groups of patients with STEMI and NSTEMI after balancing the groups using the “pseudo-randomization” method among individuals aged 75 years and older, this may be due to the retrospective nature of the study and the small sample of patients. To further clarify the obtained data, prospective research of similar design with patient randomization at the inclusion stage is required.

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About the authors

Sergey S. Yakushin

Ryazan State Medical University

Author for correspondence.
Email: ssyakushin@yandex.com
ORCID iD: 0000-0002-1394-3791
SPIN-code: 7726-7198

MD, PhD, Professor

Russian Federation, Ryazan

Kristina G. Pereverzeva

Ryazan State Medical University

Email: pereverzevakg@gmail.com
ORCID iD: 0000-0001-6141-8994
SPIN-code: 4995-1465

MD, PhD, Associate Professor

Russian Federation, Ryazan

References

  1. Олейник Б.А., Стародубов В.И., Евдаков В.А., и др. Ассоциации показателей летальности и доступности скорой и специализированной, в том числе высокотехнологичной, медицинской помощи при остром коронарном синдроме в Российской Федерации // Российский кардиологический журнал. — 2023. — Т. 28. — № 9. — С. 27–34. [Oleynik BA, Starodubov VI, Evdakov VA, et al. Association of mortality rates and availability of emergency and specialized, including high-tech, medical services for acute coronary syndrome in the Russian Federation. Russian Journal of Cardiology. 2023;28(9):27–34. (In Russ.)] doi: https://doi.org/10.15829/1560-4071-2023-5514
  2. Паршикова Е.Н., Филиппов Е.В. Смертность от всех причин у пациентов с инфарктом миокарда с подъемом сегмента ST в зависимости от типа реперфузионной терапии (данные Рязанской области, 2018–2020 гг.) // Российский медико-биологический вестник им. академика И.П. Павлова. — 2020. — Т. 28. — № 4. — C. 479–487. [Parshikova EN, Filippov EV. Mortality from all causes in patients with myocardial infarction with elevation of ST segment depending on the type of reperfusion therapy (data of Ryazan region, 2018–2020). I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):479–487. (In Russ.)] doi: https://doi.org/10.23888/PAVLOVJ2020284479-487
  3. Содномова Л.Б., Занданов А.О., Шпак И.А., и др. Госпитальные и отдаленные исходы у пациентов с острым коронарным синдромом без подъема сегмента ST // Современные проблемы науки и образования. — 2019. — № 6. [Sodnomova LB, Zandanov AO, Shpak IA, et al. Hospital and long-term outcomes in patients with acute coronary syndrome without ST segment elevation. Modern Problems of Science and Education. 2019;6. (In Russ.)] Available from: https://science-education.ru/ru/article/view?id=29370 (accessed: 22.01.2024).
  4. Зайнобидинов Ш.Ш., Хелимский Д.А., Баранов А.А., и др. Особенности ведения пожилых пациентов с инфарктом миокарда без подъема сегмента ST: анализ факторов риска, диагностика и тактика лечения // Сибирский журнал клинической и экспериментальной медицины. — 2023. — Т. 38. — № 2. — C. 98–103. [Zaynobidinov ShSh, Khelimskii DA, Baranov AA, et al. Features of the management of elderly patients with non ST segment elevation myocardial infarction: analysis of risk factors, diagnosis and treatment strategy. The Siberian Journal of Clinical and Experimental Medicine. 2023;38(2):98–103. (In Russ.)] doi: https://doi.org/10.29001/2073-8552-2023-38-2-98-103
  5. Cockburn J, Hildick-Smith D, Trivedi U, et al. Coronary revascularisation in the elderly. Heart. 2017;103(4):316–324. doi: https://doi.org/10.29001/2073-8552-2023-38-2-98-103
  6. Lee PY, Alexander KP, Hammill BG, et al. Representation of elderly persons and women in published randomized trials of acute coronary syndromes. JAMA. 2001;286(6):708–713. doi: https://doi.org/10.1001/jama.286.6.708
  7. Negers A, Boddaert J, Mora L, et al. Determinants of invasive strategy in elderly patients with non-ST elevation myocardial infarction. J Geriatr Cardiol. 2017;14(7):465–472. doi: https://doi.org/10.11909/j.issn.1671-5411.2017.07.001
  8. Зыков М.В. Особенности течения и стратификации риска осложнений острого коронарного синдрома в сочетании с почечной дисфункцией и различной стратегией лечения (обзор литературы) // Комплексные проблемы сердечно-сосудистых заболеваний. — 2015. — № 3. — С. 68–78. [Zykov MV. The course and risk stratification of acute coronary syndrome in conjunction with renal dysfunction and various treatment strategies. Complex Issues of Cardiovascular Diseases. 2015;3:68–78. (In Russ.)] doi: https://doi.org/10.17802/2306-1278-2015-3-68-78
  9. Ложкина Н.Г., Хасанова М.Х., Толмачева А.А., и др. Факторы пятилетнего прогноза у больных, перенесших острый коронарный синдром // Российский кардиологический журнал. — 2018. — № 10. — C. 18–21. [Lozhkina NG, Khasanova MKh, Tolmacheva AA, et al. The influence of factors on five-year outcomes after acute coronary syndrome. Russian Journal of Cardiology. 2018;10:18–21. (In Russ.)] doi: https://doi.org/10.15829/1560-4071-2018-10-18-21
  10. Allen LA, O’Donnell CJ, Camargo CA Jr, et al. Comparison of long-term mortality across the spectrum of acute coronary syndromes. Am Heart J. 2006;151(5):1065–1071. doi: https://doi.org/10.1016/j.ahj.2005.05.019
  11. Ren L, Ye H, Wang P, et al. Comparison of long-term mortality of acute ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome patients after percutaneous coronary intervention. Int J Clin Exp Med. 2014;7(12):5588–5592.
  12. Goldberg RJ, Currie K, White K, et al. Six-month outcomes in a multinational registry of patients hospitalized with an acute coronary syndrome (the Global Registry of Acute Coronary Events [GRACE]). Am J Cardiol. 2004;93(3):288–293. doi: https://doi.org/10.1016/j.amjcard.2003.10.006
  13. Nikus KC, Eskola MJ, Virtanen VK, et al. Mortality of patients with acute coronary syndromes still remains high: a follow-up study of 1188 consecutive patients admitted to a university hospital. Ann Med. 2007;39(1):63–71. doi: https://doi.org/10.1080/08037060600997534
  14. Fokkema ML, James SK, Albertsson P, et al. Outcome after percutaneous coronary intervention for different indications: long-term results from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). EuroIntervention. 2016;12(3):303–311. doi: https://doi.org/10.4244/EIJY15M10_07
  15. Montalescot G, Dallongeville J, Van Belle E, et al. STEMI and NSTEMI: are they so different? 1 Year outcomes in acute myocardial infarction as defined by the ESC/ACC definition (the OPERA registry). Eur Heart J. 2007;28(12):1409–1417. doi: https://doi.org/10.1093/eurheartj/ehm031
  16. Suzuki M, Nishihira K, Takegami M, et al. Clinical profiles and outcomes in the treatment of acute myocardial infarction in Japan of aging society. Heart Vessels. 2020;35(12):1681–1688. doi: https://doi.org/10.1007/s00380-020-01654-5
  17. Chang SS, Lu CR, Chen KW, et al. Prognosis between ST-Elevation and Non-ST-elevation Myocardial Infarction in Older Adult Patients. Front Cardiovasc Med. 2022;8:749072. doi: https://doi.org/10.3389/fcvm.2021.749072
  18. Четвертое универсальное определение инфаркта миокарда (2018) // Российский кардиологический журнал. — 2019. — № 3. — С. 107–138. [Fourth universal definition of myocardial infarction (2018). Russian Journal of Cardiology. 2019;3:107–138. (In Russ.)] doi: https://doi.org/10.15829/1560-4071-2019-3-107-138
  19. Aissaoui N, Puymirat E, Delmas C, et al. Trends in cardiogenic shock complicating acute myocardial infarction. Eur J Heart Fail. 2020;22(4):664–672. doi: https://doi.org/10.1002/ejhf.1750
  20. Elbadawi A, Elgendy IY, Mahmoud K, et al. Temporal trends and outcomes of mechanical complications in patients with acute myocardial infarction. JACC Cardiovasc Interv. 2019;12(18):1825–1836. doi: https://doi.org/10.1016/j.jcin.2019.04.039
  21. Yılmaz S, Adalı MK, Kılıç O, et al. Predictors of in-hospital mortality in very eldery patients presenting with acute coronary syndrome: A single-center study. Turk Kardiyol Dern Ars. 2019;47(1):38–44. doi: https://doi.org/10.5543/tkda.2018.68792
  22. Aslanger E, Yıldırımtürk Ö, Şimşek B, et al. A new electrocardiographic pattern indicating inferior myocardial infarction. J Electrocardiol. 2020;61:41–46. doi: https://doi.org/10.1016/j.jelectrocard.2020.04.008
  23. Littmann L. South African flag sign: a teaching tool for easier ECG recognition of high lateral infarct. Am J Emerg Med. 2016;34(1):107–109. doi: https://doi.org/10.1016/j.ajem.2015.10.022
  24. Переверзева К.Г., Дубова Н.В., Бирюков С.А., и др. Синдром Велленса в клинической практике // Рациональная фармакотерапия в кардиологии. — 2023. — Т. 19. — № 4. — С. 367–374. [Pereverzeva KG, Dubova NV, Biryukov SA, et al. Wellens’ syndrome in clinical practice. Rational Pharmacotherapy in Cardiology. 2023;19(4):367–374. (In Russ.)] doi: https://doi.org/10.20996/1819-6446-2023-2927
  25. Барбараш О.Л., Дупляков Д.В., Затейщиков Д.А., и др. Острый коронарный синдром без подъема сегмента ST электрокардиограммы. Клинические рекомендации 2020 // Российский кардиологический журнал. — 2021. — Т. 26. — № 4. — С. 149–202. [Barbarash OL, Duplyakov DV, Zateischikov DA, et al. 2020 Clinical practice guidelines for Acute coronary syndrome without ST segment elevation. Russian Journal of Cardiology. 2021;26(4):149–202. (In Russ.)] doi: https://doi.org/10.15829/1560-4071-2021-4449
  26. Бойцов С.А., Алекян Б.Г., Шахнович Р.М., и др. Что меняется в лечении острого коронарного синдрома в Российской Федерации? // Рациональная фармакотерапия в кардиологии. — 2023. — Т. 18. — № 6. — С. 703–709. [Boytsov SA, Alekyan BG, Shakhnovich RM, et al. What is changing in the treatment of acute coronary syndrome in the Russian Federation? Rational Pharmacotherapy in Cardiology. 2022;18(6):703–709. (In Russ.)] doi: https://doi.org/10.20996/1819-6446-2022-12-14

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