Post-hospital Mortality Forecast in Young and Middle-Aged Patients with Myocardial Infarction
I Study Objective: to find out the role of anamnestic, clinical-laboratory and instrumental characteristics in the risk of mortality in young and middle-aged patients with myocardial infarction (MI), and to propose a risk classification model for this patient cohort. Materials and Methods. The study included 424 patients with confirmed MI in patients of < 60 years old. All patients underwent clinical examination; upon admission, a 12-lead ECG, general blood analysis and biochemical blood assay as well as myocardial necrosis markers tests were performed; echocardiography was conducted to identify local hypokinesia areas and to assess LVEF; neutrophilic lymphocytic index (NLI) was measured. The one-year mortality rate caused by any factor was 6.6% (n = 28). Study Results. According to the single-factor analysis, the most important predictors of one-year mortality in young and middle-aged patients with MI were LVEF of < 40% upon discharge, acute heart failure of second-class or higher (Killip classification), heart rate of > 100 upon admission, cardiogenic shock, postinfarction cardiosclerosis, NLI of > 4.52, mitral regurgitation, Hb of < 130 g/L, high comorbidity (Charleson index of > 4). Multi-factor analysis allowing to determine the cumulative role of the above parameters demonstrated that the risk of mortality within 12-month follow-up has statistically significant correlation with NLI of > 4.52 (р = 0.04), Hb of < 130 g/L (р = 0.013), discharge LVEF of < 40% (р = 0.0001). Area under ROC curve of the resulting risk model was 0.88, with sensitivity and specificity of 85.7% and 90.9%, respectively. Conclusion. This prognostic model is cost effective and allows classifying patients with high mortality risk within first follow-up year. Calculation of an individual mortality risk will make it possible to optimise the strategy of therapy and secondary prevention in this group of patients. Materials and Methods. The study included 424 patients with confirmed MI in patients of < 60 years old. All patients underwent clinical examination; upon admission, a 12-lead ECG, general blood analysis and biochemical blood assay as well as myocardial necrosis markers tests were performed; echocardiography was conducted to identify local hypokinesia areas and to assess LVEF; neutrophilic lymphocytic index (NLI) was measured. The one-year mortality rate caused by any factor was 6.6% (n = 28). Study Results. According to the single-factor analysis, the most important predictors of one-year mortality in young and middle-aged patients with MI were LVEF of < 40% upon discharge, acute heart failure of second-class or higher (Killip classification), heart rate of > 100 upon admission, cardiogenic shock, postinfarction cardiosclerosis, NLI of > 4.52, mitral regurgitation, Hb of < 130 g/L, high comorbidity (Charleson index of > 4). Multi-factor analysis allowing to determine the cumulative role of the above parameters demonstrated that the risk of mortality within 12-month follow-up has statistically significant correlation with NLI of > 4.52 (р = 0.04), Hb of < 130 g/L (р = 0.013), discharge LVEF of < 40% (р = 0.0001). Area under ROC curve of the resulting risk model was 0.88, with sensitivity and specificity of 85.7% and 90.9%, respectively. Conclusion. This prognostic model is cost effective and allows classifying patients with high mortality risk within first follow-up year. Calculation of an individual mortality risk will make it possible to optimise the strategy of therapy and secondary prevention in this group of patients.