Clinical-anamnestic, laboratory-instrumental, structural and functional peculiarities of older age patients 6 months after myocardial infarction
Acute myocardial infarction is one of the most studied diseases, however, despite many clinical studies, elderly patients remain an unexplored group of patients, since they are often a criterion for exclusion from clinical trials.Paper reveals clinical-anamnestic, laboratory-instrumental, structural and functional characteristics of patients, as well as the peculiarities of an increase in the concentration of markers of myocardial fibrosis in older age groups who have undergone acute coronary syndrome with ST-segment elevation, 6 months after underwent revascularization by percutaneous coronary intervention are considered. Data obtained from our own prospective, open, controlled study which lasted from the onset of myocardial infarction to 6 months after. Тhe text provides the characteristic features of patients of older age groups, their distinctive characteristics from middle-aged patients, and also explains these features based on the data obtained in the study. The paper also presents the results of the concentration of markers of myocardial damage (MMP-9), and the difference in the increase between elderly patients and younger groups is proved. The study proved a decrease in heart rate in middle-aged and elderly patients by 20–25 %, and an increase by 1.2 % in elderly patients 6 months after myocardial infarction. Regardless of the age of the patients, there is a deterioration in renal function due to an increase in blood creatinine concentration by 15–25 % (p < 0,05), which is associated with hypoperfusion of blood flow through the renal tissue due to a decrease in cardiac output. In middle-aged and elderly patients, an improvement in the systolic function of the left ventricular myocardium was determined due to an increase in the ejection fraction by 5–6 % to the values of the relative intact ejection fraction (50–60 %), however, in elderly patients there is no increase in the ejection fraction, which remains at the values borderline values (40–50 %) (p < 0,05). The preservation of high concentrations of MMP-9 in elderly patients 6 months after a heart attack was determined, exceeding the reference values by 50 %, with normalization in middle-aged and elderly patients (p < 0,05). All of the above indicates the need for an individual approach to the prescribed drug therapy, further treatment tactics in elderly patients, which indicates the need for an individual approach to prescribed drug therapy, further treatment tactics in elderly patients.
Bukatov V.V. 2021. Clinical-anamnestic, laboratory-instrumental, structural and functional peculiarities of older age patients 6 months after myocardial infarction. Challenges in Modern Medicine. 44 (3): 332–342 (in Russian). DOI: 10.52575/2687-0940-2021-44-3-332-342
While nobody left any comments to this publication.
You can be first.
Osipova O.A. Bukatov V.V. 2020. Osobennosti techeniya infarkta miokarda s pod"emom segmenta ST u bol'nyh pozhilogo i starcheskogo vozrasta [Features of myocardial infarction with ST segment elevation in patients of the older age group]. Research Results in Biomedicine. 6 (3): 402–416. DOI:10.18413/2658-6533-2020-6-3-0-10 (in Russian).
Bagai A., Chen A.Y., Ude J.A., McManus D.D., Maurer M.S., Enriquez J.R., Hochman J., Goyal A., Henry T.D., Gulati M., Garratt K.N., Roe M.T., Alexander K.P. 2019. Association of Cognitive Impairment With Treatment and Outcomes in Older Myocardial Infarction Patients: A Report From the NCDR Chest Pain-MI Registry. J. Am. Heart. Assoc. 8 (17): e012929. DOI: 10.1161/JAHA.119.012929.
Chen H.Y., Gore J.M., Lapane K.L., Yarzebski J., Person S.D., Gurwitz J.H., Kiefe C.I., Goldberg R.J. 2015. A 35-year Perspective (1975–2009) into the Long-term Prognosis and Hospital Management of Patients Discharged from the Hospital after a First Acute Myocardial Infarction. Am. J. Cardiol. 116 (1): 24–29. DOI: 10.1016/j.amjcard.2015.03.035.
Deckers K., Schievink S.H.J., Rodriquez M.M.F. 2017. Coronary heart disease and risk for cognitive impairment or dementia: Systematic review and meta-analysis. Meta-Analysis. 12 (9): e0184244. DOI: 10.1371/journal.pone.0184244.
Ertaş F.S., Tokgözoğlu L. 2016. Pre- and in-hospital antithrombotic management patterns and in-hospital outcomes in patients with acute coronary syndrome: data from the Turkish arm of the EPICOR study. Anatol. J. Cardiol. 16 (12): 900–915.
Gu S.Z., Beska B., Chan D., Neely D., Batty J.A., Adams-Hall J., Mossop H., Qiu W., Kunadian V. 2019. Cognitive Decline in Older Patients With Non ST Elevation Acute Coronary Syndrome. Journal of the American Heart Association. 88 (4): e011218. DOI: 10.1161 /JAHA.118.011218.
Gudnadottir G.S., James S.K., Andersen K., Lagerqvist B., Thrainsdottir I.S., Ravn-Fischer A., Varenhorst C., Gudnason T. 2019. Outcomes after STEMI in old multimorbid patients with complex health needs and the effect of invasive management. American Heart Journal. 211: 11–21. DOI: 10.1016/ j.ahj.2019.01.008,
Jun Pu, Song Ding, Heng Ge, Yaling Han, Jinchen Guo, Rong Lin, Xi Su, Heng Zhang, Lianglong Chen, Ben He. 2017. Efficacy and Safety of a Pharmaco-Invasive Strategy With Half-Dose Alteplase Versus Primary Angioplasty in ST-Segment-Elevation Myocardial Infarction: EARLY-MYO Trial (Early Routine Catheterization After Alteplase Fibrinolysis Versus Primary PCI in Acute ST-Segment-Elevation Myocardial Infarction). EARLY-MYO Circulation. 136 (16): 1462–1473. DOI: 10.1161/CIRCULATIONAHA.117.030582.
Kalyuzhin V.V., Teplyakov A.T., Solovtsov M.A. 2016. Remodeling of the left ventricle: one or more scenarios? Bulletin of Siberian medicine. 15 (4): 120–139.
Kocayigit I., Yaylaci S., Osken A., Aydın E., Sahinkus S., Can Yu., Genc A.B., Gunduz H. 2019. Comparison of effects of thrombolytic therapy and primary percutaneous coronary intervention in elderly patients with acute ST-segment elevation myocardial infarction on in-hospital, six-month, and one-year mortality. Arch. Med. Sci. Atheroscler. Dis. 27 (4): 82–88. DOI: 10.5114/amsad.2019.85378.
Kotseva K., Wood D., Bacquer D.D., Backer G.D., Rydén L., Jennings C., Gyberg V., Amouyel P., Bruthans J., Conde A.C., Cífková R., Deckers J.W., Sutter J.D., Dilic M., Dolzhenko M., Erglis A., Fras Z., Gaita D., Gotcheva N., Goudevenos J., Heuschmann P., Laucevicius A., Lehto S., Lovic D., Miličić D., Moore D., Nicolaides E., Oganov R., Pajak A., Pogosova N., Reiner Z., Stagmo M., Störk S., Tokgözoğlu L., Vulic D. 2016. A European Societyof Cardiology survey on the lifestyle, risk factorand therapeutic management of coronarypatients from 24 European countries. Eur. J. Cardiol. 23 (6): 636–648. DOI:10.1177/2047487315569401.
Levine D.A., Davydow D.S., Hough C.L., Langa K., Rogers M.A.M., Iwashyna T.J. 2014. Disability and Cognitive Impairment After Hospitalization for Myocardial Infarction and Stroke. Circulation: Cardiovascular Quality and Outcomes. 7 (6): 863–871. DOI: 10.1161/HCQ.0000000000000008.
Melen Y.P., Skybchik V.A., Fedechko M.Y., Kopchak L.M. 2020. Effect of primary stenting of coronary arteries on clinical course and remodeling of the left ventricle in patients with acute st segment elevation myocardial infarction (results after 12 months). Wiad. Lek. 73 (1): 68–72. DOI:10.31928/2305-3127-2019.1.2128.
Osipova O.A., Zhernakova N.I., Belousova O.N., Pushkareva A.E. 2017. Cardiac mechanisms of chronic heart failure development in patients with ischemic heart disease, postman arctic cardiosclerosis of the elderly. Drug Invention Today. 9 (3): 39–43.
Sugiyama T., Hasegawa K., Kobayashi Y., Takahashi O., Fukui T., Tsugawa Y. 2015. Differential time trends of outcomes and costs of care for acutemyocardial infarction hospitalizations by ST elevation and type of intervention in the United States, 2001–2011. J. Am. Heart Assoc. 4 (3): 414–428. DOI:10.1161/JAHA.114.001445.
Wang X., Khalil R.A. 2018. Matrix Metalloproteinases, Vascular Remodeling, and Vascular Disease. Adv Pharmacol. 81: 241–330. DOI: 10.1016/bs.apha.2017.08.002.
Wojtkowska I., Stępińska J., Stępień-Wojno M., Sobota M., Kopaczewski J., Reszka Z., Kurzelewski M., Medina J. 2017. Current patterns of antithrombotic and revascularization therapy in patients hospitalised for acute coronary syndromes. Data from the Polish Subset of the EPICOR Study. Kardiol. Pol. 75 (5): 445–452. DOI:10.1056/NEJMoa1817083.
Yong-Gang Sui, Si-Yong Teng, Jie Qian, Yuan Wu, Ke-Fei Dou, Yi-Da Tang, Shu-Bin Qiao, Yong-Jian Wu. 2019. Invasive versus conservative strategy in consecutive patients aged 80 years or older with non-ST-segment elevation myocardial infarction: a retrospective study in China. J. Geriatr. Cardiol. 16 (10): 741–774. DOI: 10.11909/j.issn.1671-5411.2019.10.006.
Yudi M.B., Jones N., Fernando D., Clark D.J., Ramchand J., Jones E., Dakis R., Johnson D., Chan R., Islam A., Farouque O., Horrigan M. 2016. Management of Patients Aged ≥ 85 Years With ST-Elevation Myocardial Infarction. Am. J. Cardiol. 118 (1): 44–48. DOI: 10.1016/j.amjcard.2016.04.010.
Zhang H., Yin Y., Liu Y., Zou G., Huang H., Qian P., Zhang G., J. Zhang. 2020. Necroptosis Mediated by Impaired Autophagy Flux Contributes to Adverse Ventricular Remodeling after Myocardial Infarction. Biochem Pharmacol. 14 (175): 113915 doi: 10.1016/j.bcp.2020.113915.