Laboratory and instrumental parameters associated with the long-term mortality risk in patients after myocardial infarction
Natalia A. Mushikhina , Elena A. Gorbatenko , Alina I. Teploukhova , Elena I. Yaroslavskaya , Olga N. Larionova
Kazan medical journal ›› 2024, Vol. 105 ›› Issue (6) : 869 -878.
Laboratory and instrumental parameters associated with the long-term mortality risk in patients after myocardial infarction
BACKGROUND: The risk of death remains high in patients who survive 1 year after myocardial infarction (MI).
AIM: To identify the laboratory and instrumental parameters of myocardial remodeling associated with long-term mortality in patients 1 year after MI.
MATERIAL AND METHODS: The study included 184 patients who survived 1 year after MI. Group 1 included living patients who were followed up for 5 years after MI (n = 160). group 2 comprised patients who had died by the 5-year mark (n = 24). Inflammation and myocardial dysfunction biomarkers and echocardiographic parameters reflecting types of left ventricular remodeling, linear dimensions of cardiac cavities, wall thickness, chamber volumes, and systolic ventricular function were retrospectively analyzed. After analyzing the distribution of numerical data, the Student’s t-test or Mann–Whitney U test and χ2 test for categorical variables were applied. A logistic regression model was developed. This model was validated and assessed for reliability using the receiver operator characteristics curve, Hosmer–Lemeshow goodness-of-fit test, and bootstrap method.
RESULTS: Patients in group 2 were older (p = 0.007) and more likely to experience ST-segment elevation MI during hospitalization (p < 0.001). One year after the MI, a complex pattern of N-terminal brain natriuretic propeptide level changes was observed, with a decrease in group 1 and an increase in group 2. The end-diastolic volume index (p = 0.014) and left ventricular asynergy size were higher (p = 0.043) and the ejection fraction was lower (p = 0.015) in group 2 than in group 1. The model for predicting 4-year mortality in patients who survived MI during the first year includes parameters such as the left ventricular end-diastolic volume index, N-terminal pro-brain natriuretic peptide level, and presence of concentric left ventricular hypertrophy.
CONCLUSION: In patients who survive 1 year following MI, long-term mortality risk is associated with parameters reflecting left ventricular remodeling and heart failure development.
myocardial infarction / long-term mortality risk / left ventricular remodeling / NT-proBNP
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