DILATATION OF LEFT VENTRICUL AND EJECTION FRACTION AS FACTORS OF SURVIVAL IN PATIENTS WITH INTRACORONARY THROMBOLYSIS IN ACUTE MYOCARDIAL INFARCTION: 10-YEARS FOLLOW UP
Authors: Vesna Bisenic, Branislav Milovanovic, Sanja Djordjevic, Aleksandra Djokovic, Jelena Saric, Nebojsa Ninkovic, Slavica Radovanovic, Marija Zdravkovic, Jasmina Andrejic-Kalaba, Ruzica Pokrajac, Mirjana Krotin
Background: It is little known about the factors that determine long-term prognosis of patients after acute myocardial infarction(AMI).
Aims: To establish the factors that determine long-term survival of patients threated with intracoronary thrombolytic therapy in AMI. We were stading the influence of: ejection fraction of left ventricul (EFLV), dilatation of left ventricul and heart failure (HF) during the 10-years follow up period.
Methods: 80 patients were included in stady, all with the first AMI threated with intracoronary thrombolysis (Streptocinase) within the first 6 hours. There were 63 (78,8%) male and 17(21,2%) female of average age 54,6±8,2years.44(55,0%) patients with anteroseptal and 36 (45,0%) with inferoposterior AMI.The mean follow up period was 11,1±3,4years. During this period we determined EFLV(%), dilatation of LV (echocardio- graphy), and heart failure(cllinicaly).
RESULTS: Intrahospital mortality was 5(6,2%), total 36 (45,0%) and cardiovascular 28(35,0%). Mean EFLV was 44,9± 9,4%, among alive patients 49,4±9,4% and dead 39,6± 5,9% (p=0,0000). 28(35,0%) patients had EFLV<40% during 10-years follow up period, dead 20 (71,4%) and alive 8(28,6%)(p=0,000). The mean LV dyastolic diameter(EDD) was 57,5±4,6cm, among alive56,5±5,8cm, and dead 58,6±2,0cm with statisticly significant difference(t=0,036). The mean LV systolic diameter(ESD) was 42,4±5,9cm(among alive 41,4±7,2 and dead 43,6±3,8 without significant difference). During the follow up period 42(52,5%) patients developed dilatation of LV, alive 17(40,5%) and dead 25(59,5%) (p<0,01). Heart failure was appeared to 26(32,5%) patients, alive 8(30,8%) and dead 18(69,2%)(p=0,003). Kaplan-Meier curve showed: EF<40% was important for total(p=0,0000) and cardiovascular survival(p=0,0000); LV dilatation was important for total(0,00074) and cardiovascular survival (p=0,0129) too; and failure for total(p=0,0000) and cardiovascular survival(p=0,0000). Univariate Cox regression showed that all of three parameters were important: EF<40%(p=0,0001,RR=3,68,Cl=1,90-7,14); heart failure(p=0,0048, RR=2,59,Cl=1,34-5,03); LV dilatation (p=0,0114, RR=2,50, Cl=1,23-5,10). In multi- variate analysis EF<40% was the most predominant factor for long term survival after AMI(p=0,0001, RR= 3,68, Cl=1,90-7,14).
Conclusion: Progressive LV dilatation and heart failure are important factors wich determine long-term survival of patients after AMI, but HF is the most important.