I.B. BAZINA, O.A. KOZYREV, S.K. ZUBKOV, YA.V. VINOKUROVA, YA.V. MUSEYCHUK, A.A. CHENTSOVA, A.V. BAIDRAKOVA

 Smolensk State Medical University, Smolensk

Contact details:

Bazina I.B. — PhD (Medicine), Associate Professor of the Department of Hospital Therapy

Address: 28 Krupskaya St., 214018 Smolensk, Russian Federation, tel.: +7-919-047-22-27, e-mail: billy_boss@mail.ru

Myocardial infarction currently remains the leading cause of death in cardiovascular pathology. Identifying the factors predicting death in myocardial infarction is an important task of modern cardiology, especially for patients of working age.

The purpose — to identify the risk factors that most significantly determine the fatal outcome of type I myocardial infarction in men of working age.

Material and methods. Male patients under 65 with type 1 acute myocardial infarction were examined, who were treated in the emergency Cardiology Department of Smolensk Clinical Emergency Hospital. Group 1 consisted of patients with fatal outcome, group 2 — of patients without fatal outcome (control group).

Results. 83 men under 65 years of age were examined. The first group included 30 patients with type 1 MI with a fatal outcome, with the average age 58.7 (5.7) y. o. The 2^nd control group included 53 patients with type 1 MI without fatal outcome, with the average age 55.6 (4.8) y. o. (p = 0.01). In both groups, anterior MI localization dominated. Circular, the most unfavorable, MI was significantly more common in group 1; repeated MI was almost 5 times more frequent; fatal complications and rhythm disturbances significantly prevailed. Diabetes mellitus in group 1 was 53.3%, in group 2 — 11.3% (p ≤ 0.05). In group 1, significantly lower levels of plasma lipids and GFR, higher levels of glucose, troponin, and APTT were detected. A significantly lower left ventricular EF was found in group 1 (39.9 (10.4) %) compared to the control group (47.9 (6.3) %) (p ≤ 0.0007), as well as higher pulmonary artery pressure (40.1 (18.2) %) and 30.0 (4.7) % (p ≤ 0.0003). As repeated CAG showed, 10.7% of patients of group 1 had stent retrombosis, which reflects their extremely unstable clinical condition and significant damage to the CA. Acute thrombosis of KA was more common in group 1, both independent and combined with stenosis.

Conclusion. The most significant factors that influenced the fatal outcome in type 1 MI in men under the age of 65 were: acute thrombosis of infarct-dependent CA or thrombosis combined with coronary artery stenosis; low GFR (≤ 60 ml/min, low left ventricular EF (≤ 40%); diabetes mellitus; repeated MI with pulmonary edema, cardiogenic shock and ventricular fibrillation.

Key words: myocardial infarction, risk factors, fatal outcome.

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