Background: The clinical profile of acute myocardial infarction (AMI) patients reflects the burden of risk factors in the general population. Differences between incident (first) and recurrent (repeated) events and their impact on treatment are poorly described. We studied potential differences in the clinical profile and in-hospital treatment between patients hospitalised with an incident and recurrent AMI.
Methods: A total of 324 patients admitted in the Coronary Care Unit of 'Mother Teresa' hospital, Tirana, Albania (2013-2014), were included in the study. Information on AMI type, complications and risk factors was obtained from patient's medical file. Logistic regression analyses were used to explore differences between the incident and recurrent AMIs regarding clinical profile and in-hospital treatment.
Results: Of all patients, 50 (15.4%) had a prior AMI. Compared to incident cases, recurrent cases were older (P=0.01), more often women (P=0.01), less educated (P=0.01), and smoked less (P=0.03). Recurrent cases experienced more often heart failure (HF) (OR=2.48; 95% CI: 1.31-4.70), impaired left ventricular ejection fraction (OR=1.97; 95% CI:1.05-3.71), and multivessel disease (OR=6.32; 95% CI: 1.43-28.03) than incident cases. In-hospital use of beta-blockers was less frequent among recurrent compared to incident cases (OR=0.45; 95% CI: 0.24-0.85), while no statistically significant differences between groups were observed regarding angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, statin, aspirin or invasive procedures.
Conclusion: A more severe clinical expression of the disease and underutilisation of treatment among recurrent AMIs are likely to explain their poorer prognosis compared to incident AMIs.
Ozadje: Klinični profil pacientov z akutnim miokardnim infarktom (AMI) odraža breme dejavnikov tveganja v splošni populaciji. Razlike med prvim in ponovnimi pojavi in njihovim vplivom na zdravljenje so slabo opisani. Raziskali smo morebitne razlike v kliničnem profilu in bolnišničnim zdravljenjem pri pacientih s prvim pojavom AMI in tistih s ponovnim pojavom.
Metode: V raziskavo je bilo skupno vključenih 324 pacientov, ki so bili v letih 2013-2014 sprejeti na Enoto za koronarno nego bolnišnice Matere Terezije v Tirani v Albaniji. Iz kartotek pacientov so pridobili podatke o vrsti AMI, zapletih in dejavnikih tveganja. Za ugotavljanje razlik med prvimi in ponovnimi AMI so bile uporabljene analize logistične regresije z upoštevanjem kliničnega profila in bolnišničnega zdravljenja.
Rezultati: Med vsemi pacienti jih je 50 (15,4%) že enkrat doživelo AMI. V primerjavi s pacienti s prvim pojavom so bili tisti s ponovnimi pojavi starejši (P=0,01), pogosteje so bile to ženske (P=0,01), imeli so nižjo izobrazbo (P=0,01) in so manj kadili (P=0,03). Pacienti s ponovnimi pojavi so v primerjavi s pacienti s prvim pojavom pogosteje izkusili odpoved srca (OR=2,48; 95% CI: 1,31–4,70), oslabljeno izmetno frakcijo levega prekata (OR=1,97; 95% CI: 1,05–3,71) in multivaskularno bolezen (OR=6,32; 95% CI: 1,43–28,03). Uporaba beta-blokatorjev v bolnišnični obravnavi je bila manj pogosta pri pacientih s ponovnim pojavom v primerjavi s pacienti s prvim pojavom AMI (OR=0,45; 95% CI:0,24–0,85), medtem ko ni bilo opaziti statistično pomembnih razlik v zvezi z uporabo zaviralcev angiotenzinske konvertaze/blokatorjev receptorjev angiotenzina, statinov, aspirina ali invazivnih postopkov.
Zaključek: Resnejša klinična slika bolezni in manjša poraba zdravil med pacienti s ponovnim pojavom AMI tako lahko razložita njihovo slabšo prognozo v primerjavi s pacienti s prvim pojavom AMI.
Keywords: Albania; acute myocardial infarction; epidemiology; in-hospital treatment; prevention.