Abstract
Objectives. Assessment of prognostic significance of NT-proBNP level and the effects of invasive (I) and conservative (C) treatment of acute myocardial infarction (AMI) in patients over 65. Materials and Methods. One-year survival was assessed in 286 consecutive patients with AMI aged 65–100 (79 ± 8) subjected to I or C treatment (136 and 150 individuals), respectively. Results. 245 (85%) patients survived in-hospital stay: 124 (91.1%) received I treatment and 121 (80.6%) received C treatment. Heart failure (HF) was diagnosed in 30 patients receiving I treatment (22.6%) and in 71 subjected to C treatment (47.3%), p < 0,0001. NT-proBNP levels in the latter group were significantly higher than in the 185 patients without HF (12311 ± 13560 pg/mL versus 4773 ± 8807 pg/mL, p < 0.0001). NT-proBNP levels after coronary angioplasty were lower than in patients receiving C treatment (5922 ± 10250 pg/mL versus 8718 ± 12024 pg/mL, p = 0.0002). Left ventricular ejection fraction was significantly higher in I patients than in C patients (47 ± 13% versus 42 ± 11.6%, p = 0.004). During the one-year follow-up, 82.3% of I patients and 61.2% of the C patients survived (p < 0.0003). There was a significantly lower probability of death at NT-proBNP below 8548.5 pg/mL. Conclusions. The NT-proBNP level in the first day of AMI is a good prognosticator. One-year follow-up prognosis for patients who received I treatment in the AMI is better than that for C patients. I patients exhibit superior left ventricular function after angioplasty and in the follow-up.
Highlights
Postinfarction heart failure is an increasing medical and epidemiological problem, especially in the group of patients aged over 65 years, despite the ever more effective treatments available in the acute phase of myocardial infarction [1]
The patients, suffering from myocardial infarction confirmed by elevated troponin I levels, were admitted to the cardiologic intensive care unit. 139 of their number were diagnosed with ST-elevation myocardial infarction in ecg (STEMI), while the remaining 147 were diagnosed with non-ST elevation myocardial infarction (NSTEMI). 136 patients were subjected to invasive therapy (PCI), while 150 received conservative treatment
This mechanism was confirmed in the group of patients we studied: upwards of half of their number (51%) were hospitalized more than 12 hours after the onset of symptoms. This delay resulted from prolonged hospital preadmission procedures, often because the elderly patients had problems in precisely identifying the onset of the coronary incident; some of them refused to consent to invasive treatment
Summary
Postinfarction heart failure is an increasing medical and epidemiological problem, especially in the group of patients aged over 65 years, despite the ever more effective treatments available in the acute phase of myocardial infarction [1]. Persons are afflicted with impaired relaxation of the ventricular cardiac muscle leading to elevated end-diastolic pressure and increased NT-proBNP secretion, symptoms affected by deteriorating kidney function and the associated hypervolemia. Given the large number of factors contributing to increased natriuretic peptide levels in the elderly, the normal NT-proBNP ranges in persons over 65 greatly exceed those in the younger age groups [2, 3]. We have assessed the effects of invasive versus conservative therapies applied in the acute phase of myocardial infarction in patients over 65 on the patients’ survival and on the incidence of cardiac insufficiency over a one-year follow-up period
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