The role of specific risk factors on the prognosisof acute myocardial infarction
Skoda Réka
Theoretical and Translational Medicine
Dr. Kellermayer Miklós
SE Városmajori Klinikák Tanterme
2025-11-24 14:00:00
Cardiovascular Disorders: Physiology and Medicine of Ischaemic Circulatory Diseases
Dr. Merkely Béla
Dr. Becker Dávid
Dr. Szabó Gergely
Dr. Kenyeres Péter
Dr. Járai Zoltán
Dr. Kiss Dénes
Dr. Kupó Péter
On the basis of examining more than 10 000 patients it is predictable that with an invasive aspect of care higher mortality rates seen in the literature can be avoided.
Early invasive strategy contributes to decrease mortality rates in women. We found that traditional risk factors - higher cholesterol levels, type of the infarction, heart failure - do not play part at younger age. It pays attention to the need for studying the clinical appearance and risk factors of acute myocardial infarction of the young.
Our results confirmed the negative prognostic impact of diabetes on survival. Diabetes has more prognostic value than the type of the myocardial infarction but still left ventricle - and renal function are the leading survival modifying factors. Our study was conducted prior to the disease modifying drug-era. At that time, we called attention to the potential beneficial effect of the new diabetes drugs (SGLT-2 inhibitors, GLP-1 antagonists). Since than their morbidity and mortality modifying effect is proven.
Despite the invasive strategy patients surviving early ventricular fibrillation (EVF) have worse prognosis. We have proven that EVF is an independent risk factor for mortality regardless of age. In the first 3 years past the index event, younger patients surviving EVF have worse survival chances compared to older ones without EVF. At this 3-year turning point age becomes more important regarding survival than the EVF. Our other new finding was that the prognosis had no correlation with the extent of the coronary artery disease either at lower or at higher age in non-ST-segment elevation myocardial infarction (NSTEMI). Studying the time of EVF (with respect to the timing of intervention), it impacted the prognosis in older but not in younger patients.
We have proven that generally it is safe to wait 6 weeks as offered in the guidelines with the decision of a possible ICD implantation. We could select those patients who would benefit from a closer follow up - patents with poor general condition at discharge, those with in good condition but having reduced LV function, NSTEMI. Practically, it is safe to wait at patients in good general condition, but patients with the mentioned risk factors benefit from a close follow up and might need an earlier device implantation.
It refers to the confirmation of our results, that the ESC 2023 Acute Coronary Syndrome Guideline recommends an early CRT/ICD implantation in special patient groups.
