CAN HYPERTENSION EXPLAIN THE DIFFERENT SEASONAL EVOLUTION OF STEMI PATIENTS?

Abstract

Abstract Objective: To determine the impact of hypertension on evolution of a STEMI population studied during winter and summer months. Design and method: We reviewed the local STEMI registry data. Data were recorded from the in-hospital medical charts and from a phone follow-up with patients/family. Hospitalization inform consent stipulates the possibility of follow-up for research purposes. Results: We reviewed the 2018 data from a local STEMI registry We analyzed 470 patients admitted with STEMI in a primary PCI hospital from a temperate region. We reviewed 247 (52.6%) patients admitted during 3 winter months and 223 (47.4%) during 3 summer months and we interviewed 32.6% (153) patients for follow-up. In-hospital death-rate was 7.9% (37 patients), with death-rate at follow-up to 13.2% (62 patients). A higher in-hospital mortality was noted for winter (10,5% vs. 4,9%, X2 = 5,05, p = 0,025), while at follow-up a similar evolution was noted (16,7% vs. 9.5%, x2 = 5,35, p = 0,021). A higher median blood pressure was recorded for the alive STEMI patients at discharge (132,09 ± 23,64 mmHg vs. 107,15 ± 38,84 mmHg; t (463) = 5,524; p = 0,000) and at follow-up (131,94 ± 23,56 mmHg vs. 118,60 ± 36,3 mmHg; t (460) = 3,73; p = 0,000). During wintertime, the maximum in-hospital Killip class was higher (x2 = 9,28, p = 0,026); Killip class was higher in dead persons, initialy and after discharge. At follow-up, patients were asked to self-report their exercise capacity. A lower BP level was noted for higher exercise tolerance - NYHA I, 140,92 ± 20,66 mmHg, p = 0.04), NYHA II (141,25 ± 17,24 mmHg, p = 0.06), both compared with lower exercise tolerance - NYHA III-IV (162.33 ± 29,45 mmHg, p = 0.04); differences were significant (ANOVA test (F (3) = 4.53, P = 0.005). Limitations. The phone interview was performed at different time interval after discharge, 17,11 ± 5,48 months for winter group, and 16,23 ± 0.89 months for summer (T (468) = 2,37, p = 0.018) with a low rate of answers. Evaluation of larger cohorts is needed for further validation of the results. Conclusions: The course of a STEMI patient is critical. It's valuable to predict evolution upon the level of cardiovascular risk factors. A good high blood pressure control migth further improve outcome.