D.V. Kryuchkov, G.V. Artamonova
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo

Abstract. Rates of hospital mortality from myocardial infarction depend upon many factors: clinical profile of patients, diagnostic and treatment methods in use, organization and quality of care in a particular health care setting.

Aim: to identify medical and social factors affecting hospital mortality from myocardial infarction in a specialized heart hospital.

Data and methods. Data for study was continuous retrospective patient database, that includes 4349 patients with myocardial infarction admitted in 2008-2011. Analysis of quantitative data calculated mean and standard deviation (M±SD using Mann-Whitney test and Kruskal-Wallis test. To compare quality data frequency (F) was calculated using Pearson χ-squared criterion. p <0.05 was accepted as critical level of statistical significance.

Results. In 2008-2011, a total of 536 patients died from myocardial infarction, 57.5% of them - from recurrent infraction. The average age of patients added up to 72.7 ± 10.6 years. In 52.0% of cases the cause of death was cardiogenic shock. 48.3% of the dead had a disability status.

In the structure of hospital mortality the share of mortality within 24 hours averaged 33.6±4.3%. The average level of mortality within 24 hours equals to 4.1±1.0%.

Hospital mortality was 12.3 ±2.0%; mortality from myocardial infarction complicated with cardiogenic shock added up to 82.7±9.6%; mortality from primary myocardial infarction equaled to7.4± 1.6% and from recurrent myocardial infarction – 23.8±4.5% (p = 0.0001).

Hospital mortality depends upon patients’ age: mortality in patients of working age was 4.9±0.7%, and 12.7±2.4% - in patients of retirement age, and 25.7±5.2% (p=0,0001) in senile age patients.

Hospital mortality rate is higher among women (1.3 ± 3.2%) compared to men (9.6 ± 1.4, p = 0.0001). Hospital mortality among the disabled patients (14.7 ± 3.8%) is higher compared to patients without disability (10.6 ± 2.5, p = 0.0001).

Hospital mortality of patients without reperfusion was 16.0±4.2%, and 8.0±1.1% (p = 0.0001) - in case of reperfusion.

Conclusion. Factors that negatively affect hospital mortality rates include recurrent myocardial infarction, cardiogenic shock, female gender, disability, old age and conservative patient management.

Keywords: hospital mortality; mortality within 24 hours; myocardial infarction; cardiogenic shock; tactics of treatment of patients.

References:

1. Batsigov Kh.A., Sayfutdinov R.G., Tagirova D.R., Murtazina G.R. The strategy of “open artery” with myocardial infarction. Kazanskiy meditsinskiy zhurnal. 2010; 91 (3): 323-325 (in Russian).
2. Boytsov S. A. Mortality and lethality from circulatory diseases: an urgent need in development of the first aid for their reduction. Kardiovaskulyarnaya terapiya i profilaktika. 2007; (4): 86-95 (in Russian).
3. Bokeriya L.A., Stupakov I.N., Samorodskaya I.V., Bolotova E.V., Ocheret T.S. Myocardial infarction: how much does the official statistics reflect the problem? Kardiovaskulyarnaya terapiya i profilaktika. 2008; (8): 75-79 (in Russian).
4. Gabinskiy Ya.L. Your heart is in good hands: innovation technologies in the treatment of acute myocardial infarction. Ural'skiy kardiologicheskiy zhurnal. 2008; (3): 6-11 (in Russian).
5. Gabinskiy Ya.L. The structure of lethality in patients with acute coronary syndrome at a pre-hospital stage. Kardiovaskulyarnaya terapiya i profilaktika. 2007; (6): 22-29 (in Russian).
6. Garganeeva A.A., Okrugin S.A., Borel' K.N., Efimova E.V. Pre-hospital lethality from acute myocardial infarction and possible ways for its reduction. Kompleksnye problemy serdechno-sosudistykh zabolevaniy. 2012; (2): 28-32 (in Russian).
7. Emel'yanov O.V., Ryvkin A.Yu., Rotar' R.Yu., Borisevich E.M., Lebedeva D.N. Specific features of development of specialized cardiac care in modern conditions. Ekonomika zdravookhraneniya. 2010; (2): 10-12. (in Russian).
8. Health care in Russia. 2013. Moscow: Rosstat; 2013. 380p. (in Russian).
9. Merkulov E. V. Use of percutaneous coronary interventions at acute coronary syndrome with ST elevation. Aktual'nye voprosy bolezney serdtsa i sosudov. 2009; (1): 39-45 (in Russian).
10. Samorodskaya I.V. Acute forms of ischemic heart disease: the need to solve the problem of comparability of data on prevalence and lethality. Aktual'nye voprosy bolezney serdtsa i sosudov. 2009; (1): 25-29 (in Russian).
11. Shames A.B., Belyakin S.A., Igonin V.A., Krashutskiy V.V., Kokhan E.P., Ivanov V.A., et al. Results of treatment of patients with acute myocardial infarction with high risk of cardiac complications. Klinicheskaya meditsina. 2011; (6): 34-37 (in Russian).
12. Erlikh A.D., Matskeplivshvili S.T., Gratsianskiy N.A., Buziashvili Yu.I. First Moscow register of acute coronary syndrome: patients’ characteristics, treatment and results during inpatient care. Kardiologiya. 2013; (12): 4-13 (in Russian).
13. Erlikh A.D.. Treatment of patients with acute coronary syndromes in hospitals with/without the possibility to perform invasive coronary procedures. Kardiologiya. 2010; (7): 8-14 (in Russian).
14. Yakushin S.S. Experience and future of developing epidemiology of acute forms of ischemic heart disease in the Russian Federation. Kardiovaskulyarnaya terapiya i profilaktika. 2009; (8): 64-71 (in Russian)
15. Widimsky P., Wijns W., Fajadet J., de Belder M., Knot J.,Aaberge L. et al. Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. European Heart Journal. 2010; 31: 943-957.

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