Effect of hypercholesterolemia on long-term prognosis in patients with acute myocardial infarction depending on the age of patients
Summary. The aim was to identify and evaluate the effect of lipid metabolism on long-term prognosis in young patients after acute myocardial infarction (MI). Object and research methods. 142 patients, predominantly male, hospitalized with acute coronary syndrome with ST segment elevation during the period 2000–2015, and who were discharged from the hospital, depending on their age, are retrospectively divided into groups: 1st (n=55) — <45 and 2nd (n=87) — ≥45 years. Subsequently, depending on the baseline low-density lipoprotein (LDL) higher or less than 4.0 mmol/l, 4 subgroups were isolated: 1A (n=21) with LDL level ≥4.0, 1B (n=34) — <4.0, 2A (n=42) — ≥4.0 and 2B (n=45) — <4.0 mmol/L. All patients were examined during hospital stay (electrocardiography, echocardiography, coronary angiography, lipidogram), and the development of endpoints (death from any cause, combined and extended combined point) during 3 and 5 years of observation was performed, ROC-analysis was performed with determination of specificity and sensitivity of predictor of development of complications. Results.In young patients of the 1A subgroup, according to the results of the coronary angiography, three-vascular lesions (14.3 and 0%, respectively) were more often noted in comparison with the older age 2A subgroup and less frequently the absence of atherosclerotic lesions of the coronary vessels. Young patients with significant hyperlipidemia (1A subgroup) had a worse prognosis (death from any cause) within 3 years (Log-rank test; p=0.017), which had a trend tendency at 5 years (Log-rank test; p=0.085), compared with subgroup 1B. Patients in the 1A subgroup also more frequently reached the combined endpoint (cardiovascular death/recurrent MI/stroke) compared with subgroup 1B within 3 years (Log-rank test; p=0.021), but after 5 years the difference was absent (p=0.194). The greatest divergence of curves was noted at achievement of the extended combined point (cardiovascular death/recurrent MI/stroke/revascularization): in patients aged <45 years with LDL level ≥4.0 mmol/L for 3 and 5 years more often the development of complications was observed (Log-rank test; p=0.002 and p=0.021, respectively) compared with patients of the same age group with a LDL level <4.0 mmol/L. Patients of the older age group (≥45 years) had no dependence of development of complications on the baseline LDL level higher or less than 4.0 mmol/L. The LDL level 4.125 mmol/L proved to be prognostically significant for the development of cardiovascular complications in the outpatient period of MI only in young patients (area under the ROC-curve 0.746 (95% confidence interval 0.59–0.90). Conclusions. In patients with acute coronary syndrome with ST segment elevation <45years in the presence of ascending hyperlipidemia (LDL level >4.0 mmol/L), widespread coronary atherosclerosis, manifested in multi-vascular lesions, unlike the older age group. Baseline LDL level ≥4.0 mmol/L has a negative effect on the course of the postinfarction period in young patients, increasing the number of complications during the 5 years of follow-up. Patients with premature development of acute MI and high LDL level, as high-risk patients, should be subjected to an individualized approach to treatment and secondary prevention with maximum active hypolipidemic therapy.
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