IN-HOSPITAL HEART FAILURE AS A PREDICTOR OF SURVIVAL IN PATIENTS WITH INTRACORONARY THROMBOLYSIS IN ACUTE MYOCARDIAL INFARCTION: 10-YEARS FOLLOW UP EXPERIENCES
Authors: Vesna Bisenic, Branislav Milovanovic, Jelena Saric, Slavica Radovanovic, Branislava Todic, Marija Zdravkovic, Slavica Banicevic, Irena Zivanovic, Lisulov Danica Popovic, Mirna Zaja, Mirjana Krotin
Background: Great number of parameters of acute phase of myocardial infarction(AMI) could determine long-term prognosis of patients after AMI.
Aims: To establish which parameters of acute phase have the greatest influence on long-term survival of patients threated with intracoronary thrombolysis in AIM.Ejection fraction of left ventricul(EFLK) after thrombolysis and heart failure in AMI(Killip) were studied.
Methods: 80 patients were included in study, mean age 54,6±8,2years. There were 63 male(78,8%), mean age 53,8±8,1 and 17 female(mean age 57,5±8,1). 44 patients had anteroseptal AMI(55%) and inferoposterior 36(45%). They all had the first AIM, threatedwith intracoronary thrombolysis(Streptocinase) within the first 6 hours. EFLK were determined by ventriculography after intracoronary thrombolysis(EF). Appearance of heart failure(HF)was established cllinicaly by Killip. The mean follow up period was 11,1±3,4 years.
Results: The mean EF was 43,7±6,9%, among alive patients 46,9±4,8%, and among dead 39,9±7,1(p=0,000). 34(42,5%) patients had EF<40% after thrombolyses. 27(79,4%) among dead patients had EF<40%, and among alives 7(20,6%), with statisticly significancy(0,000). 30(37,4%) patients had heart failure (HF) in acute phase: Killip II 24(30,0%), Killip III et IV 3(3,7%) both. Among the patients with HF, alive were 7(23,3%) and dead 23(76,7%) (p=0,000). Intrahospital mortality was 5(6,2%), total 36(45%) and cardiovascular 28(35%). Kaplan-Meier curve showed that EF was important for total survival (p=0,0000), and cardiovascular survival (p=0,0000). HF in acute phase was important for total(p=0,0000) and cardiovascular mortality(p=0,0000). Univariate Cox regression showed that both parameters were important for long-term survival after AIM: EF<40%(p=0,0000, RR=7,27, Cl=3,38-15,60) and HF(p=0,0000, RR=5,48, Cl=2,73-11,00). In multivariate analysis EF<40% was the first predominant factor(p=0,0002, RR=4,78, Cl= 2,09-10,95) for survival, and the second was HF(p=0,005, RR= 2,98, Cl=1,39-6,39).
Conclusion: Important factors for long-term prognosis of patients after AMI are: EF as well as HF. Preventing of HF and improving EF by applying modern methodes of cure, represent an imperativ that greatly affects the long-term survival of patients after MI.