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Long-term prognosis after a first myocardial infarction in Turkey: determinants of mortality and reinfarction
H Yüksel1, D Güzelsoy, N Yazicioğlu
1Department of Clinical Cardiology, Cerrahpaşa Medical Faculty, University of Istanbul, Turkey.
Insights
This study followed 718 myocardial infarction survivors for up to 10 years. Congestive heart failure, arrhythmias, and angina predicted long-term cardiac mortality and reinfarction risk.
Area of Science:
- Cardiology
- Clinical Medicine
- Public Health
Background:
- Understanding long-term outcomes after a first myocardial infarction (MI) is crucial for patient management.
- Identifying prognostic factors can guide preventative strategies and improve survival rates.
Purpose of the Study:
- To investigate the long-term prognosis of first myocardial infarction survivors.
- To identify factors associated with late cardiac mortality and reinfarction in this population.
Main Methods:
- A cohort of 718 patients surviving their first MI were followed for 1-10 years.
- Data collected included clinical characteristics, in-hospital events, and follow-up outcomes.
- Statistical analysis was performed to determine predictors of mortality and reinfarction.
Main Results:
- Cumulative mortality rates reached 36.5% by 10 years post-MI.
- Congestive heart failure during coronary care unit stay was the strongest predictor of cardiac mortality.
- Ventricular arrhythmias, left bundle branch block, and post-MI angina were also significant predictors.
- Reinfarction rates increased over time, particularly in patients receiving anticoagulants or experiencing post-MI angina.
- Type and site of MI did not independently predict mortality or reinfarction.
Conclusions:
- Long-term prognosis after a first MI in Turkey is comparable to Western populations.
- Congestive heart failure, arrhythmias, and angina are key determinants of late cardiac events.
- Prognostic factors for MI survivors are consistent across different geographical settings.
Abstract:
Long-term prognosis of a first myocardial infarction and factors associated with late cardiac mortality and reinfarction were studied in 718 survivors. Patients have been followed up for 1-10 years (mean 57.6 +/- 39.6 months). None of the patients underwent coronary bypass surgery in the follow-up period. Cumulative mortality rates were 8.6% in the first year, 17.9% in 3 years, 26.4% in 5 years and 36.5% in 10 years. The type and site of myocardial infarction (Q-wave versus non-Q-wave and anterior versus infero-posterior) were found to have no independent prognostic importance. The cardiac mortality was best predicted by the occurrence of congestive heart failure in the coronary care unit. Other determinants of late outcome were the presence of ventricular arrhythmias, left bundle branch block, and the occurrence of stable or unstable angina pectoris or reinfarction during the follow-up period. Usage of antiplatelet or anticoagulant drugs was not found to affect mortality. Reinfarction rates were 4, 9.9, 15.5 and 28% in 1, 3, 5 and 10 years, respectively, and no relation was found between the type and location of myocardial infarction and reinfarction rate. Reinfarction was higher in patients receiving anticoagulants and in patients with postmyocardial infarction angina. Our findings suggest that the prognosis of patients with a first acute myocardial infarction in Turkey is not different from that in Western populations and factors influencing prognosis are similar to those previously reported.