Pranas Šerpytis, Agnė Andruškienė, Simona Pelanytė, Vilma Matelytė, Rasa Palšauskaitė, Robertas Katliorius
Aim of study: to analyse influence of different factors on 30 days survival post-treatment rate for patients, suffering from acute myocardial infarction with ST-segment elevation and non-ST-segment elevation during 2011.
Materials and methods: retrospectively investigated 1445 case histories of patients, divided into two groups: I group – myocardial infarction with ST–segment elevation (STEMI) and II group – non-ST-segment elevation myocardial infarction (NSTEMI). Median age was 67,31 ± 0,41 years in the I group and 69,11 ± 0,5 years in the II group. The selection criteria of this research: ST segment localization and Q wave on electrocardiograms; Killip and TIMI classes; troponin I and creatinine levels; glomerular filtration rate; trombolysis with Alteplase / Tenecteplase; RIA, RCX and DVA occlusions; complications of acute myocardial infarction.
Results: 1445 patients with acute myocardial infarction (AMI) were treated. 35,78% had NSTEMI while 64.22% had STEMI. 5.6% of patients with STEMI and 3.7% with NSTEMI had a lethal outcome. In STEMI group 5.08% of females have died while in male category a statistically reliable influence of ST segment location on survival was not noted. In STEMI group, patients who were older than 54 years, had significant decrease in survival rate – 95.4% of patients have survived. 0.53% of women with NSTEMI have died. In the same group patients who were older than 65 years had even more significant decrease in survival rate – 97.4%. Furthermore, patients with DVA occlusions had a higher survival rate than patients with RIA and RCX occlusions. In both groups decrease in survival rate was observed with Killip class IV: with NSTEMI only 53.8% of patients have survived, and with STEMI – 55.55%. With Alteplase used for reperfusion 98,32% of patients have survived; with Tenecteplase – 90.22% respectively. Patients with TIMI III blood flow type had 97.4% survival rate in group I and 98.5% survival rate in group II. GFR ≥ 60 ml/min/1,73cm2 resulted in a greater survival rate of both genders. In case of cardiogenic shock patients with ST-segment elevation had a higher death rate – 51.5% of patients have survived; without ST-segment elevation MI 63.2% of the patients have survived. In both groups, patients with sepsis or multiple organ disfunction had survival rate of 50% and 28.6%, respectively.
Conclusions: women with ST-segment acute myocardial infarction have a greater possibility to survive after treatment. Killip I – II and TIMI III classes, glomerular filtration rate ≥ 60 ml/ min/1,73 cm2 result in better survival rates. The high survival rate is observed after trombolysis with Alteplase or Tenecteplase in both genders. The occlusions of the right coronary artery result in better prognosis for patients with acute myocardial infarction without ST segment elevation. The three – vessel coronary disease has negative impact on patients with acute myocardial infarction without ST segment elevation. The cardiogenic shock, sepsis and multiple organ dysfunction syndrome markedly worsen the survival rate in both myocardial infarction groups.
Keyword(s): Killip class, TIMI grade flow, thrombolysis, troponin I, glomerular filtration rate
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