Utjecaj ranije kronične terapije statinima na smrtnost bolesnika s akutnim infarktom miokarda liječenih primarnom perkutanom koronarnom intervencijom

doctoral thesis

• Title (english): Impact of previous chronic statin therapy on mortality in patients with acute myocardial infarction treated with primary percutaneous coronary intervention
• Author: Nikola Kos
• Mentor: Diana Delić-Brkljačić (mentor)
• Committee member: Maja Čikeš (predsjednik povjerenstva)
• Committee member: Nikola Bulj (član povjerenstva)
• Committee member: Ivan Pećin (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2024-11-07, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine
• Universal decimal classification (UDC): 616 - Pathology. Clinical medicine

Abstract

Provedeno je prospektivno, kohortno istraživanje na seriji slučajeva koje je uključilo 2988 bolesnika (71.9% muškaraca), prosječne dobi 67 godina, koji su u razdoblju od 1. lipnja 2011. do 1. siječnja 2019. liječeni u Kliničkom bolničkom centru Sestre milosrdnice perkutanom koronarnom intervencijom zbog prvog infarkta miokarda. Kao primarni cilj istraživanja ispitivan je utjecaj ranije kronične terapije statinima na smrtnost bolesnika s infarktom miokarda. Medijan praćenja iznosio je 61 mjesec. Bolesnici su podijeljeni u dvije skupine, a ovisno o prethodnoj terapiji statinom. Analizirana je ukupna smrtnost (do kraja perioda praćenja) i kratkoročna smrtnost (unutar 30 dana od infarkta miokarda). Zasebno je analizirana opća i kardiovaskularna smrtnost. Od 2988 bolesnika, 420 (14.1%) je prethodno liječeno statinom, a u navedenoj je skupini zabilježena statistički značajnija opterećenost ranije utvrđenom aterosklerotskom bolesti i kardiovaskularnim komorbiditetima. Rezultati istraživanja nisu pokazali statistički značajnu razliku u smrtnosti među promatranim skupinama, kako kratkoročnoj tako dugoročnoj, čime je potvrđena nul-hipoteza. Promatrajući opću smrtnost, uočeno je da bolesnici prethodno liječeni statinima tijekom perioda praćenja umiru ranije od onih koji prethodno nisu liječeni statinima. Kao neovisni prediktori smrtnosti izdvojeni su: dob bolesnika, šećerna bolest, periferna arterijska bolest, ventrikulska tahikardija i visoki Killip stupanj u trenutku prijema. Kada se promatrao tip infarkta i angiografske karakteristike, uočeno je da su bolesnici liječeni statinima češće imali NSTEMI i angiografski neokluzivni tip infarkta, koji je ujedno bio i prediktor smrtnosti. Među laboratorijskim nalazima i rezultatima oslikavanja vrijednosti hemoglobina i ejekcijske frakcije lijevog ventrikula su se pokazale kao neovisni prediktori smrtnosti. Ovo istraživanje pokazalo je kako SCORE2 sustav dobro predviđa rizik smrti bilo kojeg uzroka bolesnika nakon infarkta miokarda, neovisno o prethodnom liječenju statinima. I visokorizični i nevisokorizični bolesnici imaju jednaku smrtnost tijekom perioda praćenja, neovisno o ranijem liječenju statinom.

Abstract (english)

A prospective cohort study was conducted on a series of cases involving 2988 patients (71.9% male), with an average age of 67 years, who were treated at the Sestre milosrdnice University Hospital from June 1, 2011, to January 1, 2019, with percutaneous coronary intervention due to their first myocardial infarction.
The primary aim of the study was to examine the impact of prior chronic statin therapy on mortality in patients with myocardial infarction. The median follow-up period was 61 months. Patients were divided into two groups based on previous statin therapy. Overall mortality (until the end of the follow-up period) and short-term mortality (within 30 days of myocardial infarction) were analyzed. All-cause and cardiovascular mortality were analyzed separately. Out of the 2988 patients studied, 420 (14.1%) had previously been treated with statins, and this group showed a statistically significant higher burden of previously diagnosed atherosclerotic disease and cardiovascular comorbidities. The results of the study did not show a statistically significant difference in mortality between the observed groups, both short-term and long-term, thus confirming the null hypothesis. Observing all-cause mortality, it was noted that patients previously treated with statins died earlier during the follow-up period than those who had not been previously treated with statins. Independent predictors of mortality included: patient age, diabetes mellitus, peripheral arterial disease, ventricular tachycardia, and high Killip class at admission. When considering the type of infarction and angiographic characteristics, it was noted that patients treated with statins more often had NSTEMI and angiographically non-occlusive type of infarction, which was also a predictor of mortality. Among the laboratory findings and imaging results, hemoglobin levels and ejection fraction were shown to be independent predictors of mortality. This study demonstrated that the SCORE2 system effectively predicts all-cause mortality, regardless of prior statin use. Both high-risk and non-high-risk patients did not show different mortality rates depending on prior statin therapy.

• Keywords: STEMI; NSTEMI; statini; primarna perkutana koronarna intervanija; SCORE2
• Keywords (english): STEMI; NSTEMI; statins; primary percutaneous coronary intervention; SCORE2
• Language: croatian
• URN:NBN: urn:nbn:hr:105:085271
• 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: 134 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-11-28 10:29:05