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01 July 1997

Myocardial infarction in women. Part II - analysis of long-term survival and prognostic factors during 2-year follow-up

Zbigniew Religa, Maria Krzemińska-Pakuła, Zbigniew Bednarkiewicz, Dorota Skirzyńska

Med Sci Monit 1997; 3(4): CR524-529 :: ID: 501359

Abstract

The aim of the study was to analyse the outcome of women after first acute myocardial infarction (MI) compared to men during 2-year follow-up. The main end-points: cardiac death, rate of reinfarction and recurrent angina were evaluated and the percentage of coronary angiography, PTCA and surgical revascularisation were analysed. Study population consisted of 83 women (mean age 58.1 years) admitted to the Cardiological Department of the Medical Academy in ü-d with a diagnosed first MI. Patients were divided into subgroups according to their age. The control group was formed of 235 men hospitalised in the Clinic during the same period. During follow-up all patients underwent several diagnostic procedures including: physical examination, ECG, 24-hour Holter monitoring and two-dimensional echocardiography. First examination (B0) was performed before discharge (14.7 day after acute MI), second (B1) at 6th month, third (B2) at 12th month and the last one (B3) at 24th month. In each control visit clinical status according to NYHA classification, left ventricular ejection fraction (EF), ventricular rhythm disturbances (Lown classification), presence of painful/painless myocardial ischaemia during Holter monitoring were assessed. Chi squared and Fisher tests were used for the assessment of the correlation between all variables (p.<0.05). For multivariate analysis the logistic regression model was calculated. During two-year follow-up 13 cardiac deaths occurred in womenOs group (15.6%) compared to 25 (10.6%) in men - p.<0.01. The rate of reinfarction was also significantly higher in women (32.1% vs 18.4%) and especially in older ones. Retrospectively, most indices of cardiac instability (85.3 recurrences of angina, 81.2% of reinfarction and 61.5% of cardiac deaths) occurred within the first 12 months after the acute phase of MI. The main predictors of poor prognosis after MI were: severe ventricular arrhythmia (III Lown class or more), cardiac failure (III-IV NYHA class), poor left ventricular function (EF<40%), painful and mixed ischaemia detected by Holter monitoring and age above 56 years. As in the first part of the study sex was an independent factor of increased risk of cardiac complications in women after the first acute MI.

Keywords: Coronary Artery Disease, Women, acute myocardial infarction, long-term prognosis

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750