PREDICTORS OF RECURRENT ISCHEMIC DAMAGES IN MEN UNDER 60 YEARS OF AGE WITH MYOCARDIAL INFARCTION

Background. Early post-infarction angina and recurrent myocardial infarction (MI) negatively influence prognosis of the disease. In this context it is important to improve prophylaxis of these conditions. Aim. Determination of most significant predictors of recurrent ischemic damages in MI in men under 60 years of age with the aim of improvement of their prophylaxis. Materials and Methods. Results of treatment of men with MI aged 18-60 years have been studied St. Petersburg, Russia. A group of study involved 95 patients (mean age 50.5±5.3 years) with episodes of recurrent ischemia (recurrent MI and/or early post-infarction angina). A control group involved 471 patients (mean age 50.9±6.4 years) with MI without the mentioned complications. A comparative assessment of risk factors for cardiovascular pathology, of factors that provoke MI, determine its clinical course, complications and prognosis of MI was performed in these groups. Risk for development of recurrent damages was analyzed using chi-square method. The resultant models were verified by ROC-analysis. Results. The most significant precursors of recurrent ischemia were multivascular damages, history of MI, multiple MI complications including thromboembolism in the pulmonary circulation, acute heart failure of III and higher functional class (according to T. Killip) combined with tobacco smoking, hypodynamia; duration of the post-infarction period more than a year, unstable angina and bypass surgery in history, stressful situations as causes of MI, dyslipidemia in acute and subacute MI periods, pulmonary hypertension (PH) at the end of the third week of MI in association with a low level of quality of life linked with acute heart failure in the first hours of the disease. These factors, situations and their combinations should be used for elaboration of prognostic models for assessment of the risk of recurrent damages. Conclusions. Identification of a group with the high risk for recurrent episodes of ischemia associated with the above factors, in the first hours of MI, is important for timely diagnosis, more complete revascularization, monitoring and treatment of the above MI complications, which will permit to improve the prognosis of these patients.