FEATURES OF THE STRUCTURE AND DEGREE OF SEVERITY OF COMORBID PATHOLOGY AND RISK FACTORS OF DEVELOPMENT OF MYOCARDIAL INFARCTION IN PATIENTS OF A PROFILE HOSPITAL
Introduction: The presence of high comorbidity, risk factors lead to a worsening of the course and an unfavorable outcome of acute myocardial infarction (AMI). Taking into account gender and age characteristics, the study of the most important risk factors will help in the future create activities focused on combating comorbidity. The main benefit of this work is the identification and management of high-risk patients.
The aim of the study: study of risk factors, structure and severity of comorbid pathology and its influence on the clinical course of AMI in different gender-age groups of patients.
Materials and methods: The retrospective study included case histories of 634 patients with a favorable outcome of AMI. The study group is represented by 63.9% of men and 36.1% of women. The comorbidity of AMI patients was assessed using the Charlson comorbidity index (IC). The patients were divided into 3 groups: Group I (low comorbidity, ICR≤3 points); Group II (average comorbidity, CI 3-5 points); Group III (high comorbidity, CI ≥5 points).
Results and discussion: Compared to women, men were more likely to have AH 89.7%, hypercholesterolemia 75%, overweight 40%, smoking 31.5%, obesity 31%, diabetes mellitus 24.4% and impaired glucose tolerance in 20% of patients. The average number of nosologies was 3.7 ± 1.04. The Charlson comorbidity index is 5.5 ± 1.9 points. There was a high 47.3% and moderate comorbidity of 48.3%. A high comorbidity index was found in men (49.7%), in women (50.3%). Patients with high comorbidity often had recurrent AMI (59.1%, p = 0.001). A direct correlation was found between the severity of coronary artery disease, age, and the severity index of comorbidity (r = 0.32, p = 0.001). Compared to the three women, the vascular lesion of the coronary bed was more detected in men 64.1%, p = 0.001. Considering the structure and severity of comorbid pathology in patients with AMI, there was a low 10-year survival rate according to the comorbidity index.
Conclusion: Most of the patients with risk factors and comorbid pathology were men. The patients with AMI studied by us had high and moderate comorbidity; more often these patients had repeated AMI, multivessel coronary artery disease and a decrease in the frequency of coronary angiography, then PCI. When calculating the comorbidity index, a low 10-year survival rate was revealed. This work proves the need for timely correction of risk factors, improvement of comorbidity management tactics, which helps to reduce the unfavorable course of AMI.
Kamilya M. Kedelbaeva 1, https://orcid.org/0000-0002-7645-2009
Salim F. Berkinbaev 1, https://orcid.org/0000-0003-2489-8276
Gulnar A. Dzhunusbekova 1, https://orcid.org/0000-0001-7452-5625
Meyramgul K. Tundybaeva 1, https://orcid.org/0000-0001-9202-7451
Aizhan Sh. Kubeyeva 1, https://orcid.org/0000-0002-4616-724Х
1 S.D. Asfendiyarov Kazakh National Medical University, Almaty c., Republic of Kazakhstan;
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22. Rocca W.A., Boyd C.M., Grossardt B.R., et al. Prevalence of multimorbidity in a geographically defined American population: patterns by age, sex, and race/ethnicity. Mayo Clin Proc. 2014;89(10):1336- 49. doi: 10.1016/j.mayocp.2014.07.010
23. Sauver J.L., Boyd C.M., Grossardt B.R., et al. Risk of developing multimorbidity across all ages in an historical cohort study: differences by sex and ethnicity. BMJ Open. 2015;5(2):e006413. doi: 10.1136/bmjopen-2014-006413
24. Worrall-Carter L., McEvedy S., Wilson A., Rahman M.A. Gender Differences in Presentation, Coronary Intervention, and Outcomes of 28,985 Acute Coronary Syndrome Patients in Victoria, Australia. Women’s Health Issues. 2016;26(1):14-20. doi:10.1016/j. whi.2015.09.002.
25. Fortin M., Hudon C., Haggerty J. et al. Prevalence estimates of multimorbidity: a comparative study of two sources. BMC Health Serv Res 10, 111 (2010). https://doi.org/10.1186/1472-6963-10-111.
26. Hall M., Dondo T..B, Yan A.T., et al. Multimorbidity and survival for patients with acute myocardial infarction in England and Wales: Latent class analysis of a nationwide population-based cohort. PLOS Medicine. 2018;15(3):e1002501. doi:10.1371/journal. pmed.1002501.
27. Holzer B.M., Siebenhuener K., Bopp M. et al. Evidence-based design recommendations for prevalence studies on multimorbidity: improving comparability of estimates. Popul Health Metrics 15, 9 (2017). https://doi.org/10.1186/s12963-017-0126-4.
28. Charlson M.E. et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J. of Chronic Diseases. 1987. Vol. 40. – P. 373–383. doi: 10.1016/0021-9681(87)90171-8.
29. Schmidt F.P., Schmitt C., Hochadel M., et al. Invasive treatment of NSTEMI patients in German Chest Pain Units — Evidence for a treatment paradox. International Journal of Cardiology. 2018;255:15-9. doi:10.1016/j.ijcard.2017.11.018.
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Библиографическая ссылка
Kedelbaeva K.M., Berkinbaev S.F., Dzhunusbekova G.A., Tundybaeva M.K., Kubeyeva A.Sh. Features of the structure and degree of severity of comorbid pathology and risk factors of development of myocardial infarction in patients of a profile hospital // Nauka i Zdravookhranenie [Science & Healthcare]. 2021, (Vol.23) 4, pp. 113-122. doi 10.34689/SH.2021.23.4.012Похожие публикации:
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