Influence of Demographic, Anamnestic
and Clinical Factors on the Hospital Mortality of Patients with Acute Myocardial Infarction
Cagáň S.1,2, Wimmerová S.1, Besedová I.1,2, Trnovec T.1
1Ústav preventívnej a klinickej medicíny, Bratislava, Slovenská republika, riaditeľ doc. MUDr. Štefan Nyulassy, DrSc.2Slovenská postgraduálna akadémia medicíny, Bratislava, Slovenská republika, riaditeľ prof. MUDr. Ján Štencl, CSc. |
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Summary:
The objective of the work was to analyze local priority data on the possible effect of demographic,
anamnestic and clinical factors in a non-selected population of 3123 patients with acute myocardial
infarction (AIM) on the hospital mortality (HM). 12.6 % patients with AIM died in hospital. The
mean age of those who died was 71.92 years. There were more than 4 times more patients above 64
years than 64-year-old ones or younger ones who died. The mortality rate of 64-year-old patients
and younger ones (5.2 % is significantly lower than in patients above 64 years (19 %). The mortality
rate of patients above 74 years was 27.1 %. Important correlations of the HM were moreover
found - in women, patients living permanently in rural areas, in widowed subjects, in patients
with elementary education, old age, pensioners and non-smokers. The HM was lower (< 10 %) in
patients with a history of complex ventricular arrhythmias, impaired lipid metabolism and those
who had no other serious disease in the case-history. A higher HM (> 15 %) was recorded in
patients with a history of a cerebrovascular attack, with data on heart failure and in diabetic
patients. The majority of patients (39.4 % of all who died) died within 24 hours after admission.
During the first three days 57 % patients died. Analysis of the characteristic of AIM and HM
revealed some clinically important data on the HM less than 30 % (patients with complicated AIM,
with elevated ST segments, with a left ventricular ejection fraction of less than 40 % and with and
concurrent heart failure). An adverse course of the disease with a high HM (> 30 %) was found in
patients with complications of AIM. It was highest, more than 60 %, in patients after implemented
cardiopulmonary resuscitation, in patients with a combination of three markers of imminent
shock and patients in shock.The local priority findings on the HM assembled in Slovakia in
a non-selected population of patients with AIM confirm that the high HM still persists in patients
of advanced age and in women. It is adversely influenced also by some demographic data, educational
level, some anamnestic and clinical factors. The HM of patients with AIM may be adversely influenced also by side-effects of protracted economic transformation which is under way. Data
assembled in Slovakia are comparable with similar results assembled in other countries.
Key words:
Acute myocardial infarction - Hospital lethality - Demographic, anamnestic and clinical
factors - Clinical audit
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