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[Predictive factors for survival and for a second coronary event in patients with a first acute myocardial infarct]
G Rodríguez-Abrego1, J Escobedo-de la Peña, A Unzueta Montoya
1Coordinación de Salud Comunitaria y Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, D.F.
Insights
Ejection fraction, a measure of heart function, is a key predictor of recurrent myocardial infarction. Diabetes and hypertension are significant risk factors for delayed death after a first heart attack.
Area of Science:
- Cardiology
- Clinical Medicine
- Public Health
Background:
- Prognosis after acute myocardial infarction (MI) depends on coronary obstruction severity and left ventricular function.
- Left ventricular ejection fraction (LVEF) is a key indicator of cardiac function post-MI.
Purpose of the Study:
- To assess the predictive value of LVEF and cardiovascular risk factors for a second MI and delayed mortality.
- To identify patients at high risk for adverse outcomes after their first MI.
Main Methods:
- A cohort of 161 patients hospitalized for a first acute MI was followed for 1 to 51 months.
- Ejection fraction was measured using transthoracic echocardiography.
- Cox survival analysis was employed to evaluate prognostic indices.
Main Results:
- The incidence rate for a second MI was 0.01052/month, and the mortality rate was 0.00342/month.
- LVEF emerged as a major prognostic index; LVEF < 40% indicated a sevenfold higher risk of a second MI.
- Diabetes mellitus and hypertension were significant predictors of delayed death.
Conclusions:
- Ejection fraction is the most significant predictor of a second MI.
- LVEF, diabetes, and hypertension are valuable for predicting delayed death post-MI.
- Identifying high-risk patients allows for targeted preventive strategies.
Abstract:
Prognosis after an acute myocardial infarction is closely related to the severity of coronary obstruction, and the residual functionality of left ventricle, which may be evaluated by the ejection fraction. To evaluate the utility of the ejection fraction and some cardiovascular risk factors, as predictors of a second myocardial infarction and delayed death, in those patients with a first acute myocardial infarction, 161 hospitalized patients were included in the study. The occurrence of a second myocardial infarction or death after the first month was evaluated. All patients were followed for 1 to 51 months, and the ejection fraction through a transthoracic echocardiogram was measured. 119 men and 42 women were included in the study, with a total of 3802 person-months of follow-up. The incidence rate for a second myocardial infarction was 0.01052 month,-1 and the mortality rate was 0.00342 month-1. In a Cox survival analysis model, ejection fraction was a major prognostic index and those subjects with an ejection fraction below 40% had a seven fold higher risk for a second myocardial infarction. Diabetes mellitus and hypertension were major predictors of a delayed death after a first myocardial infarction. Ejection fraction is the most related variable to the occurrence of a second myocardial infarction, and together with a history of diabetes and hypertension are good predictors of a delayed death after a first myocardial infarction. The identification of subjects with a poor prognosis may allow to establish specific preventive measures. Ejection fraction is useful to categorize patients according to their prognosis.