Possibilities and limitations for rehabilitation in males under 60 years old with myocardial infarction, complicated by acute kidney injury

Authors:

Gordienko Aleksander Voleslavovich, Grand PhD in Medical sciences, Professor, Honored Doctor of the Russian Federation, Professor of the Hospital Therapy Department, S.M. Kirov Military Medical Academy, 6 Akademika Lebedeva Street, 194044 St. Petersburg, Russian Federation; e-mail: gord503@mail.ru; https://orcid.org/0000-0002-6901-6436.

Tassybayev Bolat Bayazyldanovich, adjunct at the Hospital Therapy Department, S.M. Kirov Military Medical Academy, 6 Akademika Lebedeva Street, 194044 St. Petersburg, Russian Federation; e-mail: vmeda-nio@mil.ru; https://orcid.org/0000-0003-3322-6375.

Sotnikov Aleksey Vladimirovich, Grand PhD in Medical sciences, Professor, Hospital Therapy Department, S.M. Kirov Military Medical Academy, 6 Akademika Lebedeva Street, 194044 St. Petersburg, Russian Federation; e-mail: vmeda-nio@mil.ru; https://orcid.org/0000-0002-5913-9088.

Barsukov Anton Vladimirovich, Grand PhD in Medical sciences, Professor, senior lecturer, Hospital Therapy Department, S.M. Kirov Military Medical Academy, 6 Akademika Lebedeva Street, 194044 St. Petersburg, Russian Federation; +78122923467; e-mail: avbarsukov@yandex.ru; https://orcid.org/0000-0002-1943-9545.

Chumak Boris Anatolyevich, PhD in Medical sciences, Associate Professor, Head of the Hospital Therapy Department, S.M. Kirov Military Medical Academy, 6 Akademika Lebedeva Street, 194044 St. Petersburg, Russian Federation; e-mail: vmeda-nio@mil.ru; https://orcid.org/0000-0002-5010-7661.

Menshikova Alexandra Nikolaevna, adjunct at the Hospital Therapy Department, S.M. Kirov Military Medical Academy, 6 Akademika Lebedeva Street, 194044 St. Petersburg, Russian Federation; e-mail: vmeda-nio@mil.ru; https://orcid.org/0000-0001-9422-4969.

Nosovich Dmitry Vladimirovich, lecturer, Hospital Therapy Department, S.M. Kirov Military Medical Academy, 6 Akademika Lebedeva Street, 194044 St. Petersburg, Russian Federation; e-mail: vmeda-nio@mil.ru; https://orcid.org/0000-0003-2891-4747.

Ziva Irma Igorevna, student, faculty of training doctors, S.M. Kirov Military Medical Academy, 6 Akademika Lebedeva Street, 194044 St. Petersburg, Russian Federation; e-mail: vmeda-nio@mil.ru; https://orcid.org/0000-0003-3197-9963.

Annotation:

Introduction. Acute kidney injury in myocardial infarction worsens its prognosis. At the same time, most of the data was obtained for patients over 60 years old. There is very little information about the methods and methods of cardiorehabilitation in such patients.

Aim. To evaluate the characteristics of cardiovascular risk factors, the course of the disease and manifestations of heart failure in men younger than 60 years old with myocardial infarction, complicated by acute kidney injury, to improve prevention and improve outcomes.

Materials and methods. The study included men 32—60 years old with type I myocardial infarction. The patients were divided into two age-comparable groups: I — study group, with acute kidney injury — 25 patients; II — the control one, without acute kidney injury — 486 patients. A comparative analysis of the frequency of observation of cardiovascular risk factors, features of clinical phenotypes, manifestations of heart failure in the first 48 hours (1) and at the end of the third week of the disease (2), their dynamics in acute kidney injury was performed.

Results. The cardiovascular risk factors stricture in the study group was: atherogenic dyslipidemia (100 %), smoking (92 %), physical inactivity (88 %), arterial hypertension (80 %), overweight (80 %; in the comparison group — 47 %; p = 0.002), peripheral angiopathy (80 % and 57 %, respectively; p = 0.02), psycho-emotional stress (64 % and 46 %; p = 0.04), chronic foci of infections (64 %), myocardial infarction and surgical revascularization operations history (48 %), chronic heart failure (36 % and 14 %; p = 0.006), inflammatory lung disease (36 %) and peptic ulcer disease (32 % and 14 %; p = 0.01), alcohol abuse (32 %), urolithiasis (24 %), diabetes mellitus (16 %). The same prevalence of the cerebrovascular variant of the disease, late arrhythmias and recurrent ischemia in the studied groups was noted. The study group (4 %) differed from the control group (22 %) in a lower incidence of acrocyanosis (p = 0.03) and liver enlargement (8 % and 26 %, respectively; p = 0.046) at the end of the eighth week of illness.

Discussion. Thus, the prevalence of risk factors for cadiovascular pathology in men under 60 with myocardial infarction complicated by acute kidney injury is extremely high (more than three factors per patient), which exacerbates the problem of repeated vascular catastrophes and increases the need to cover such patients with cardiac rehabilitation programs.

Conclusion. Men under 60 years old with acute kidney injury due to myocardial infarction are characterized by a high prevalence of cardiovascular risk factors (more than three per patient) and a higher incidence of heart failure. This must be considered when drawing up programs for cardiorehabilitation and monitoring their implementation.

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