Risk Factors for Adverse One-year Prognosis in Patients With Low Left Ventricular Ejection Fraction After Myocardial Infarction and Chronic Cerebral Ischemia

Background: Recent studies have reported the correlation between left ventricular dysfunction and asymptomatic carotid artery stenosis So, we aimed to determine the predictors of poor long-term survival in patients with left ventricular systolic dysfunction after MI and chronic cerebral ischemia. Methods: 182 patients with left ventricular failure and chronic cerebral ischemia presented with Q-wave MI were recruited in a observational study. Of them, 149 (81.9%) were men and 33 (18.1%) were women. Their median age was 60.4 (53; 69) years. All patients underwent echocardiography, coronary angiography, carotid color duplex scanning, and were consulted by an interventional neurologist at the acute phase of MI. One year after MI, the hard endpoints were collected. Univariate and multivariate regression analyzes were performed. Results: Cerebral arteriopathy was confirmed in all patients from the study group. The thickness of the intima-media was over 1.0 mm. The mean carotid intima-media thickness was 1.8±06 mm. The majority of patients had mild to moderate encephalopathy. Carotid atherosclerotic plaques were found in 37.4% of patients. The degree of stenosis did not exceed 50% in all cases. One-year after MI, 77 (46.1%) patients reached hard endpoints. The multivariate regression model showed that previous stroke (RR 7.33 [95% CI 1.97-27.32], p = 0.003 ) was the most unfavorable predictor of mortality, whereas the most unfavorable predictors of endpoints were prior stroke (RR = 1.92 [95% CI 1.09-3.38], p = 0.025 ) and the presence of carotid atherosclerotic plaque (RR = 2.12 [95% CI 1.34-3.37], p = 0.001 ). Conclusion: The presence of carotid atherosclerotic plaques and previous stroke affect the one-year prognosis in patients with myocardial infarction, complicated by heart failure and chronic cerebral ischemia.