Gender and clinical parameters in the first year follow up of treatment outcomes in patients with acute coronary syndrome

doctoral thesis

• Title (english): Spol i klinički parametri u prvoj godini praćenja ishoda liječenja u pacijenata s akutnim koronarnim sindromom
• Author: Igor Tagasovski
• Mentor: Davor Miličić (mentor)
• Committee member: Diana Delić-Brkljačić (predsjednik povjerenstva)
• Committee member: Edvard Galić (član povjerenstva)
• Committee member: Nataša Antoljak (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2024-10-01, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine
• Universal decimal classification (UDC): 616 - Pathology. Clinical medicine

Abstract

Among patients with acute coronary syndrome (ACS), there are considerable disparities among European countries in gender and clinical parameters during the first-year follow-up. These differences are particularly notable in Central and Eastern European countries as opposed to their Western European counterparts. This study was conducted at the Department of Cardiovascular Diseases at the University Hospital Centre Zagreb from January 1, 2013, and December 31, 2017. The aim of this PhD thesis is to identify predictors of ACS patients who underwent primary PCI for one year follow-up. We hypothesed that male gender, age,
decreased glomerular filtration rate (GFR), bundle branch block, and left anterior descending artery (LAD) as the infarction artery will be significantly associated with one-month and oneyear mortality. The sampling method was convenient and all patients who fulfilled diagnostic and interventional criteria were included in the analyses. Sample size was more than 700 patients for the majority of analyses. Age, GFR, and LAD as the culprit artery were significant predictors for one-month and one-year mortality in the majority of analyses. Following descriptive and analytic statistics, for two follow-up periods we constructed four logistic regression models with two age cut-offs, >65 and >75 years of age. Odds rations for age, GFR, and LAD indicated increased risk for mortality. Although majority of risk factors, with the exception of age were in the >75 model, were statistically significant in the one-month models, they did not achieve significance in one-year period. Gender was not significant predictor in all four models. Our results were in line with previous studies, emphasizing the need for more comprehensive treatment and follow-up algorithms for patients with identified predictors of adverse outcomes. Data collection adjusted to clinical setting would improve clinical outcomes and efficiency of secondary prevention.

Abstract (english)

Kod pacijenata s akutnim koronarnim sindromom (AKS) postoji značajna varijacija u spolu i kliničkim parametrima tijekom prve godine praćenja. Cilj istraživanja je identificirati prediktore smrtnosti kod pacijenata koji su prebolili infarkt. Istraživanje je provedeno na Odjelu za kardiovaskularne bolesti Sveučilišne bolnice u Zagrebu od 2013. do 2017.godine. Hipoteza je da muški spol, dob, smanjena glomerularna filtracija (GFR), blok grane te lijeva prednja silazna arterija (LAD) kao infarktna arterija mogu biti značajno povezani s jednomjesečnom i jednogodišnjom smrtnošću. Dob, GFR i LAD bili su značajni prediktori za jednomjesečnu i jednogodišnju smrtnost u većini analiza. Nakon statističkih analiza, konstruirana su četiri logistička regresijska modela s dvije dobi (stariji od 65 i stariji od 75 godina) za dva razdoblja praćenja. Dob, GFR i LAD ukazivali su na povećan rizik smrtnosti. Iako je većina čimbenika rizika, osim dobi, bila statistički značajna u modelima za mjesec dana nisu postigli značajnost u jednogodišnjem razdoblju. Spol nije bio značajan prediktor u sva četiri modela. Rezultati su u skladu s prethodnim istraživanjima u vezi s povećanim rizikom za GFR i LAD, naglašavajući potrebu za sveobuhvatnijom terapijom i metodologijom praćenja pacijenata s AKS-om. Prikupljanje podataka prilagođeno kliničkom okruženju moglo bi poboljšati kliničke ishode i učinkovitost sekundarne prevencije.

• Keywords: Acute Coronary Syndrome; Cardiovascular Diseases; Percutaneous Coronary Intervention; Coronary Vessels; Infarction; Risk Factors
• Keywords (english): Akutni koronarni sindrom; Kardiovaskularne bolesti; Perkutana koronarna intervencija; Koronarne žile; Infarkt; Čimbenici rizika
• Language: english
• URN:NBN: urn:nbn:hr:105:555064
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstvo (doktor/doktorica znanosti, područje biomedicine i zdravstvo)
• Type of resource: Text
• Extent: 112
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-10-14 07:44:52