Variations in all-cause mortality in patients with myocardial infarction with elevation of the st segment according to the type of reperfusion therapy received (data of Ryazan region, 2018-2020)

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Abstract

Aim. To assess variations in all-cause mortality in patients with past myocardial infarction with elevation of the ST segment (STEMI) according to the type of reperfusion therapy received.

Materials and Methods. Among 1456 patients hospitalized with acute coronary syndrome with elevation of the ST segment, 848 cases were randomly selected for analysis. Acquisition of information of the endpoint (i.e., death from any cause) was conducted over 18 months. The published data were received on January 10, 2020, and the median observation time was 20.8 months (17.4; 23.6).

Results. The highest all-cause mortality observed after 18 months (42.3%) was found in the group of patients who did not receive reperfusion therapy. The 30-day mortality rates in the group receiving thrombolytic therapy (TLT) and the group without reperfusion therapy did not show significant differences (20.3% vs. 26.2%, р>0.05). The hospital, 30-day, 12-month, and 18-month all-cause mortality rates in the group receiving percutaneous coronary intervention (PCI) were 8.4%, 10.6%, 16.6%, and 18.3%, respectively; these values are significantly lower compared with the corresponding rates in the group that did not receive reperfusion (19.5%, 26.2%, 36.2%, and 42.3%, respectively; р<0.05). The most remarkable differences in the frequency of the endpoint were recorded at the end of the 18-month period. Specifically, mortality in the group without reperfusion mortality (42.3%) was significantly higher (р<0.05) compared with those in the groups who received TLT (27.1%), PCI (18.3%), and TLT + PCI (13.1%).

Conclusion. The lowest all-cause mortality recorded over 18 months of observation was noted in the group treated by the pharmaco-invasive approach (TLT + PCI). The highest mortality over the same period was observed in the group of patients who did not receive reperfusion therapy.

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About the authors

Elena N. Parshikova

Lubertsy Regional Hospital

Email: philpoiuy@yandex.ru
ORCID iD: 0000-0003-0349-3456
SPIN-code: 2809-2781

Head of the Emergency Department

Russian Federation, Lubertsy, Moscow region

Evgenii V. Filippov

Ryazan State Medical University

Author for correspondence.
Email: dr.philippov@gmail.com
ORCID iD: 0000-0002-7688-7176
SPIN-code: 2809-2781
ResearcherId: O-1490-2016

MD, PhD, Head of the Department of Outpatient Therapy and Preventive Medicine

Russian Federation, Ryazan

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Supplementary files

Supplementary Files
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1. Fig. 1. Mortality from myocardial infarction in the Russian Federation, with modifications by I.E. Chazova (reported to the concluding Specialist Commission on May 24, 2018)

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2. Fig. 2. Mortality in patients with STEMI according to the type of reperfusion therapy received

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Media Registry Entry of the Federal Service for Supervision of Communications, Information Technology and Mass Communications (Roskomnadzor) PI No. FS77-76803 dated September 24, 2019.



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