Short-term and long-term prognosis in patients with Q-myocardial infarction complicated by acute heart failure with hyperglycemia

Abstract

The aim was to study the short-term and long-term prognosis in patients with Q- myocardial infarction (Q-MI) complicated by acute heart failure (AHF) with hyperglycemia (HG).

Materials and methods. In total, 108 patients with Q-MI complicated by AHF with HG were examined. The mean age was 67 (60; 78) years, male – 55.5 %. Using the Kaplan-Meyer method of multiple assessments and the Cox proportional risk model, the effects of HG on admission, patients’ age and Q-MI therapy on the relative risk (RR) of in-hospital mortality, one-year mortality, re-hospitalization and total cumulative endpoint (CE) were estimated.

Results. The level of HG on admission >10.3 mmol / l significantly increased the RR of total CE by 2.1 times (CI 1.1960–3.6012, P = 0.009); >9.0 mmol / l increased the RR of in-hospital mortality by 5.78 times (BP 1.109, CI 1.322–25.293, P = 0.02) and one-year mortality by 4.75 times (CI 1.64–13.74, P  = 0.004). Patients older than 67 years had a higher RR of death within one year by 4 % (1.042 BP, CI 1.0048–1.0810, P = 0.03). Systemic thrombolytic therapy (STLT) reduced the RR of achieving total CE by 73 % (BP 0.27, CI 0.0984–0.7590, P = 0.01), ß-blockers by 60 % (BP 0.40, CI 0.2310–0.7380, p = 0.002) and AMR – by 49 % (BP 0.51 CI 0.2749–0.9288, P = 0.03). The use of eplerenone reduced the RR of total CE compared with spironolactone (OR 0.26, CI 0.1001–0.6706, P = 0.006). Patients who received AMR at a dose of 50 mg had a 2.9-fold (CI 1.0332–8.3100, P = 0.04) higher RR to achieve total CE compared with a dose of 25 mg. Using of inotropes increased the RR of total CE by 3.1 times (CI 1.7495–5.4981, P < 0.0001), in-hospital mortality by 7.1 times (CI 2.6–19.3, P = 0.0001), death within a year by 4.68 times (CI 2.19–10.01, P = 0.001). ß-blockers and drugs of ACE inhibitors or ARBs groups significantly lowered the risk of in-hospital mortality (BP 0.15, CI 0.05­–0.41, P = 0.0003) and (BP 0.25, CI 0.09– 0.67, P = 0.006), respectively. Furthermore, ß-blockers (BP 0.25, CI 0.1172–0.5380, P = 0.0004) and drugs of ACE inhibitors or ARBs groups (BP 0.34, CI 0.16–0.73, P = 0.006) reduced the risk of one-year mortality. STLT and maintaining doses of statins significantly increased survival at the hospital stage and throughout the year. The risk of re-hospitalization was reduced with AMR administration (BP 0.4, CI 0.18–0.91, P = 0.03), especially eplerenone (BP 0.17, CI 0.04–0.76, P = 0.02).

Conclusions. HG levels on admission >9 mmol/l significantly increases the risk of in-hospital mortality and death within one year in patients with Q-MI, complicated by AHF, and over 10.3 mmol / l – the risk of achieving total CE. The age of patients older than 67 years significantly increases the RR of one-year mortality. STLT and pharmacotherapy including ß-blockers reduces the risk of in-hospital mortality, one-year mortality and achieve total CE. The development of clinical conditions requiring the use of inotropic support in patients with AMI complicated by AHF and HG increases the relative risk of in-hospital mortality, one-year mortality and total CE. Using the drugs of ACE inhibitors or ARBs groups and statins at average maintaining doses reduces the risk of in-hospital mortality and one-year mortality. The pharmacotherapy of Q-MI complicated by AHF with HG including AMR decreases the risk of achieving total CE and re-hospitalization. The use of AMR at a dose of 50 mg compared with a dose of 25 mg increases the risk of achieving total CE, and eplerenone has advantages over spironolactone.