Hospital and long-term periods of myocardial infarction in comorbid men and women under 60 years

Aim of the study was to assess the impact of comorbidity on the hospital and 2-year stage of treatment for myocardial infarction (MI) in men and women under 60 years of age.

Material and methods. The analysis included 350 patients with MI younger than 60 years of age. The majority of patients (87.4 %) were men. For all patients, the risk was calculated according to the GRACE ASC Risk Model scale and an analysis was made of the severity of comorbidity according to the own model “K9” (patent RU2734993C1 from October 27, 2020), based on the summation of 9 diseases: diabetes mellitus, atrial fibrillation, stroke, arterial hypertension, obesity, peripheral atherosclerosis, thrombocytopenia, anemia, chronic kidney disease.

Results. Comorbidity (the presence of 2 or more diseases) was recorded insignificantly more often in men (65.9 % versus 53.6 %, p = 0.12). In men, but not in women, comorbidity was associated with a 23.5 % reduction in percutaneous coronary intervention (p = 0.006). Both in-hospital mortality and the risk of major cardiovascular events (death/MI/stroke) 2 years after discharge were minimal (up to 0.7 % and up to 8.1 %, respectively) in the absence of comorbidity in both men and women, higher in comorbid women (3.4 and 12.5 %, respectively) and maximum in comorbid men (6.1 and 18.4 %, respectively). Comorbidity more significantly aggravated the 2-year prognosis in patients undergoing percutaneous coronary intervention than in receiving primary conservative treatment, increasing the risk of developing the death/MI/stroke end point by 3 times (16.7 and 5.8 %, respectively, p = 0.013). The addition of comorbidity data to the GRACE scale in the Cox regression analysis can significantly improve the prognosis of the onset of the 2-year endpoint, increasing the χ² value from 64.08 to 79.86, and the value of the area under the ROC-curve (AUC) to 0.79 (95 % confidence interval (95 % CI) 0.71–0.88). At the same time, ROC analysis showed that the modified GRACE scale predicts the onset of the death/ MI/stroke endpoint in men much better than in women: AUC 0.81 (95 % CI 0.72–0.90) and AUC 0.67 (95 % CI 0.51–0.83), respectively.

Conclusions. Comorbidity is comparable to the GRACE scale and effectively predicts the likelihood of hospital mortality. At the same time, the GRACE scale has an unsatisfactory predictive value for the 2-year endpoint “death/MI/stroke”. Modification of the GRACE scale with data on comorbidity has important clinical implications in men, but not in women, allowing more effective stratification of the risk of adverse events in the long term after myocardial infarction.

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