The association between comorbidity burden with six-month mortality and clinical condition upon admission in myocardial infarction : The MADDEC study
Mattila, Esa (2022)
2022
Lääketieteen lisensiaatin tutkinto-ohjelma - Licentiate's Programme in Medicine
Lääketieteen ja terveysteknologian tiedekunta - Faculty of Medicine and Health Technology
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Hyväksymispäivämäärä
2022-01-18
Julkaisun pysyvä osoite on
https://urn.fi/URN:NBN:fi:tuni-202201171353
https://urn.fi/URN:NBN:fi:tuni-202201171353
Tiivistelmä
Background and aims: Many comorbidities associate with poor prognosis after acute myocardial infarction (AMI). Our study goal was to assess the association between significant comorbidities and AMI mortality and to quantify the risk related to multiple co-existing comorbidities.
Methods: The study population comprised consecutive AMI patients evaluated invasively by coronary angiography in a single tertiary care center in Finland between January 2007 to October 2017 (n = 7279). The association between comorbidities and mortality was evaluated by adjusted regression analysis. The primary endpoint was six-month mortality.
Results: Median age at baseline was 68.9 years (SD 12.0). A total of 594 deaths were observed during the first six-months. Significant co-occurring diseases associating with six-month mortality in age adjusted multivariable model were previous MI (HR 1.31, 95% CI 1.07-1.60, p=0.008), previous stroke (HR 1.70, 95% CI 1.35-2.15, p<0.001), diabetes (HR 1.36, 95% CI 1.14-1.62, p = 0.001), previous or prevalent (any) cancer (HR 1.56, 95% CI 1.17-2.06, p = 0.002), previous/prevalent valvular heart disease (HR 1.71, 95% CI 1.36-2.15, p<0.001) and previous peripheral arterial disease (HR 1.62, 95% CI 1.26-2.08, p<0.001). Mortality increased by number of significant comorbidities (4.7% vs. 6.6% vs. 14.4% vs. 29.4%, p<0.001, for 0 to 3 co-occurring diseases). Number of
comorbidities also associated significantly with the patients’ status as assessed by GRACE score (118.9 vs 125.5 vs. 141.6 vs. 149.1, p<0.001, from 0 to 3 co-occurring diseases co-occurring diseases).
Conclusion: Comorbidity burden associates with clinical condition upon admission and mortality after AMI.
Methods: The study population comprised consecutive AMI patients evaluated invasively by coronary angiography in a single tertiary care center in Finland between January 2007 to October 2017 (n = 7279). The association between comorbidities and mortality was evaluated by adjusted regression analysis. The primary endpoint was six-month mortality.
Results: Median age at baseline was 68.9 years (SD 12.0). A total of 594 deaths were observed during the first six-months. Significant co-occurring diseases associating with six-month mortality in age adjusted multivariable model were previous MI (HR 1.31, 95% CI 1.07-1.60, p=0.008), previous stroke (HR 1.70, 95% CI 1.35-2.15, p<0.001), diabetes (HR 1.36, 95% CI 1.14-1.62, p = 0.001), previous or prevalent (any) cancer (HR 1.56, 95% CI 1.17-2.06, p = 0.002), previous/prevalent valvular heart disease (HR 1.71, 95% CI 1.36-2.15, p<0.001) and previous peripheral arterial disease (HR 1.62, 95% CI 1.26-2.08, p<0.001). Mortality increased by number of significant comorbidities (4.7% vs. 6.6% vs. 14.4% vs. 29.4%, p<0.001, for 0 to 3 co-occurring diseases). Number of
comorbidities also associated significantly with the patients’ status as assessed by GRACE score (118.9 vs 125.5 vs. 141.6 vs. 149.1, p<0.001, from 0 to 3 co-occurring diseases co-occurring diseases).
Conclusion: Comorbidity burden associates with clinical condition upon admission and mortality after AMI.