Predictors of 1-Year Major Cardiovascular Events after ST-Elevation Myocardial Infarction in a Specialized Cardiovascular Center in Western Iran
-
Parisa Janjani
,
Sayeh Motevaseli
,
Nahid Salehi
,
Reza Heidari Moghadam
,
Soraya Siabani
,
Mahdi Nalini
Abstract
Background: Identifying the long-term predictors of recurrent cardiovascular events may help improve the quality of care and prevent subsequent events. We aimed to investigate the predictors of 1-year major cardiovascular events (MACE) in patients discharged after ST-elevation myocardial infarction (STEMI) in a tertiary hospital in Iran.
Methods: This registry-based cohort study included consecutive STEMI patients between 2016 and 2019 in Imam-Ali Hospital, Kermanshah, Iran. All patients discharged alive from STEMI hospitalization were followed up for 1 year for MACE, consisting of all-cause mortality, nonfatal MI, and nonfatal stroke. We estimated the hazard ratio (HR) and the 95% confidence interval (95% CI) using Cox proportional-hazard models to evaluate potential predictors, including demographic characteristics, medical history, cardiovascular risk factors, laboratory tests, reperfusion therapy, and medications.
Results: During 2187.2 person-years, 21 patients were lost to follow-up (success rate =99.1%). Of 2274 post-discharge STEMI patients (mean age =60.26 y; 21.9% female), 151 (6.6%) experienced MACE, including, all-cause mortality (n=115, 5.1%), nonfatal MI (n=20, 0.9%), and nonfatal stroke (n=16, 0.7%). Independent predictors of MACE were age (HR:1.02; 95% CI: 1.00–1.04), no education vs ≥12 years of formal schooling (HR: 2.07; 95% CI: 1.17–3.67), stroke history (HR: 2.37; 95% CI: 1.48–3.81), the glomerular filtration rate (HR: 0.98; 95% CI: 0.97–1.00), the body mass index (HR: 0.94; 95% CI:, 0.89–0.99), peak creatine kinase-MB (HR: 1.00; 95% CI: 1.00–1.002), thrombolysis vs primary percutaneous coronary intervention (HR: 1.85; 95% CI: 1.21–2.81), and left ventricular ejection fraction <35% vs ≥50% (HR: 2.82; 95% CI: 1.46–5.47).
Conclusion: Age, education, stroke history, the glomerular filtration rate, the body mass index, peak creatine kinase-MB, reperfusion therapy, and left ventricular function can be independently associated with 1-year MACE.
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4. Johansson S, Rosengren A, Young K, Jennings E. Mortality and morbidity trends after the first year in survivors of acute myocardial infarction: a systematic review. BMC Cardiovasc Disord 2017;17:53.
5. Wang Y, Li J, Zheng X, Jiang Z, Hu S, Wadhera RK, Bai X, Lu J, Wang Q, Li Y, Wu C, Xing C, Normand SL, Krumholz HM, Jiang L. Risk factors associated with major cardiovascular events 1 year after acute myocardial infarction. JAMA Netw Open 2018;1:e181079.
6. Timmis A, Townsend N, Gale CP, Torbica A, Lettino M, Petersen SE, Mossialos EA, Maggioni AP, Kazakiewicz D, May HT, De Smedt D, Flather M, Zuhlke L, Beltrame JF, Huculeci R, Tavazzi L, Hindricks G, Bax J, Casadei B, Achenbach S, Wright L, Vardas P; European Society of Cardiology. European Society of Cardiology: Cardiovascular disease statistics 2019. Eur Heart J 2020;41:12-85.
7. Finegold JA, Asaria P, Francis DP. Mortality from ischaemic heart disease by country, region, and age: statistics from World Health Organisation and United Nations. Int J Cardiol 2013;168:934-945.
8. Tunstall-Pedoe H, Vanuzzo D, Hobbs M, Mähönen M, Cepaitis Z, Kuulasmaa K, Keil U. Estimation of contribution of changes in coronary care to improving survival, event rates, and coronary heart disease mortality across the WHO MONICA Project populations. Lancet 2000;355:688-700.
9. Yusuf S, Islam S, Chow CK, Rangarajan S, Dagenais G, Diaz R, Gupta R, Kelishadi R, Iqbal R, Avezum A, Kruger A, Kutty R, Lanas F, Lisheng L, Wei L, Lopez-Jaramillo P, Oguz A, Rahman O, Swidan H, Yusoff K, Zatonski W, Rosengren A, Teo KK; Prospective Urban Rural Epidemiology (PURE) Study Investigators. Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low-income countries (the PURE Study): a prospective epidemiological survey. Lancet 2011;378:1231-1243.
10. Chandrashekhar Y, Alexander T, Mullasari A, Kumbhani DJ, Alam S, Alexanderson E, Bachani D, Wilhelmus Badenhorst JC, Baliga R, Bax JJ, Bhatt DL, Bossone E, Botelho R, Chakraborthy RN, Chazal RA, Dhaliwal RS, Gamra H, Harikrishnan SP, Jeilan M, Kettles DI, Mehta S, Mohanan PP, Kurt Naber C, Naik N, Ntsekhe M, Otieno HA, Pais P, Piñeiro DJ, Prabhakaran D, Reddy KS, Redha M, Roy A, Sharma M, Shor R, Adriaan Snyders F, Weii Chieh Tan J, Valentine CM, Wilson BH, Yusuf S, Narula J. Resource and infrastructure-appropriate management of ST-segment elevation myocardial infarction in low- and middle-income countries. Circulation 2020;141:2004-2025.
11. Statistical Centre of Iran. Estimation of population in Iran by province and year. https://rb.gy/vgedij (1 January 2021).
12. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD; Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol 2018;72:2231-2264.
13. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J; CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150:604-612.
14. Greenland S, Pearce N. Statistical foundations for model-based adjustments. Annu Rev Public Health 2015;36:89-108.
15. Kassaian SE, Masoudkabir F, Sezavar H, Mohammadi M, Pourmoghaddas A, Kojuri J, Ghaffari S, Sanaati H, Alaeddini F, Pourmirza B, Mir E; IPACE2 Registry Investigators. Clinical characteristics, management and 1-year outcomes of patients with acute coronary syndrome in Iran: the Iranian Project for Assessment of Coronary Events 2 (IPACE2). BMJ Open 2015;5:e007786.
16. Xavier D, Pais P, Devereaux PJ, Xie C, Prabhakaran D, Reddy KS, Gupta R, Joshi P, Kerkar P, Thanikachalam S, Haridas KK, Jaison TM, Naik S, Maity AK, Yusuf S; CREATE registry investigators. Treatment and outcomes of acute coronary syndromes in India (CREATE): a prospective analysis of registry data. Lancet 2008;371:1435-1442.
17. Huo X, Khera R, Zhang L, Herrin J, Bai X, Wang Q, Lu Y, Nasir K, Hu S, Li J, Li X, Zheng X, Masoudi FA, Spertus JA, Krumholz HM, Jiang L. Education level and outcomes after acute myocardial infarction in China. Heart 2019;105:946-952.
18. Yusuf S, Joseph P, Rangarajan S, Islam S, Mente A, Hystad P, Brauer M, Kutty VR, Gupta R, Wielgosz A, AlHabib KF, Dans A, Lopez-Jaramillo P, Avezum A, Lanas F, Oguz A, Kruger IM, Diaz R, Yusoff K, Mony P, Chifamba J, Yeates K, Kelishadi R, Yusufali A, Khatib R, Rahman O, Zatonska K, Iqbal R, Wei L, Bo H, Rosengren A, Kaur M, Mohan V, Lear SA, Teo KK, Leong D, O'Donnell M, McKee M, Dagenais G. Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. Lancet 2020;395:795-808.
19. Kubota Y, Heiss G, MacLehose RF, Roetker NS, Folsom AR. Association of educational attainment with lifetime risk of cardiovascular disease: the atherosclerosis risk in communities study. JAMA Intern Med 2017;177:1165-1172.
20. Schultz WM, Kelli HM, Lisko JC, Varghese T, Shen J, Sandesara P, Quyyumi AA, Taylor HA, Gulati M, Harold JG, Mieres JH, Ferdinand KC, Mensah GA, Sperling LS. Socioeconomic status and cardiovascular outcomes: challenges and interventions. Circulation 2018;137:2166-2178.
21. Dennison CR, McEntee ML, Samuel L, Johnson BJ, Rotman S, Kielty A, Russell SD. Adequate health literacy is associated with higher heart failure knowledge and self-care confidence in hospitalized patients. J Cardiovasc Nurs 2011;26:359-367.
22. Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol 2009;53:1925-1932.
23. Rana JS, Mukamal KJ, Morgan JP, Muller JE, Mittleman MA. Obesity and the risk of death after acute myocardial infarction. Am Heart J 2004;147:841-846.
24. Nigam A, Wright RS, Allison TG, Williams BA, Kopecky SL, Reeder GS, Murphy JG, Jaffe AS. Excess weight at time of presentation of myocardial infarction is associated with lower initial mortality risks but higher long-term risks including recurrent re-infarction and cardiac death. Int J Cardiol 2006;110:153-159.
25. Plakht Y, Shiyovich A, Weitzman S, Fraser D, Zahger D, Gilutz H. A new risk score predicting 1- and 5-year mortality following acute myocardial infarction Soroka Acute Myocardial Infarction (SAMI) project. Int J Cardiol 2012;154:173-179.
26. Nalini M, Sharafkhah M, Poustchi H, Sepanlou SG, Pourshams A, Radmard AR, Khoshnia M, Gharavi A, Dawsey SM, Abnet CC, Boffetta P, Brennan P, Sotoudeh M, Nikmanesh A, Merat S, Etemadi A, Shakeri R, Malekzadeh R, Kamangar F. Comparing anthropometric indicators of visceral and general adiposity as determinants of overall and cardiovascular mortality. Arch Iran Med 2019;22:301-309.
27. Fazel R, Joseph TI, Sankardas MA, Pinto DS, Yeh RW, Kumbhani DJ, Nallamothu BK. Comparison of reperfusion strategies for ST-segment-elevation myocardial infarction: a multivariate network meta-analysis. J Am Heart Assoc 2020;9:e015186.
28. Sim DS, Jeong MH, Ahn Y, Kim YJ, Chae SC, Hong TJ, Seong IW, Chae JK, Kim CJ, Cho MC, Rha SW, Bae JH, Seung KB, Park SJ; Korea Acute Myocardial Infarction Registry (KAMIR) Investigators. Pharmacoinvasive strategy versus primary percutaneous coronary intervention in patients with ST-segment-elevation myocardial infarction: a propensity score-matched analysis. Circ Cardiovasc Interv 2016;9:e003508.
29. Huber K, Goldstein P, Danchin N, Fox KA, Welsh R, Granger CB, Henry T, Gersh BJ. Enhancing the efficacy of delivering reperfusion therapy: a European and North American experience with ST-segment elevation myocardial infarction networks. Am Heart J 2013;165:123-132.
30. Salehi N, Motevaseli S, Janjani P, Bahremand M, Heidari Moghadam R, Rouzbahani M, Siabani S, Tadbiri H, Nalini M. Reperfusion therapy and predictors of 30-day mortality after ST-segment elevation myocardial infarction in a university medical center in western Iran. Arch Iran Med 2021;24:796-803.
31. Sarnak MJ, Amann K, Bangalore S, Cavalcante JL, Charytan DM, Craig JC, Gill JS, Hlatky MA, Jardine AG, Landmesser U, Newby LK, Herzog CA, Cheung M, Wheeler DC, Winkelmayer WC, Marwick TH; Conference Participants. Chronic kidney disease and coronary artery disease: JACC state-of-the-art review. J Am Coll Cardiol 2019;74:1823-1838.
2. Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2021 update: a report from the American Heart Association. Circulation 2021;143:e254-e743.
3. Jernberg T, Hasvold P, Henriksson M, Hjelm H, Thuresson M, Janzon M. Cardiovascular risk in post-myocardial infarction patients: nationwide real world data demonstrate the importance of a long-term perspective. Eur Heart J 2015;36:1163-1170.
4. Johansson S, Rosengren A, Young K, Jennings E. Mortality and morbidity trends after the first year in survivors of acute myocardial infarction: a systematic review. BMC Cardiovasc Disord 2017;17:53.
5. Wang Y, Li J, Zheng X, Jiang Z, Hu S, Wadhera RK, Bai X, Lu J, Wang Q, Li Y, Wu C, Xing C, Normand SL, Krumholz HM, Jiang L. Risk factors associated with major cardiovascular events 1 year after acute myocardial infarction. JAMA Netw Open 2018;1:e181079.
6. Timmis A, Townsend N, Gale CP, Torbica A, Lettino M, Petersen SE, Mossialos EA, Maggioni AP, Kazakiewicz D, May HT, De Smedt D, Flather M, Zuhlke L, Beltrame JF, Huculeci R, Tavazzi L, Hindricks G, Bax J, Casadei B, Achenbach S, Wright L, Vardas P; European Society of Cardiology. European Society of Cardiology: Cardiovascular disease statistics 2019. Eur Heart J 2020;41:12-85.
7. Finegold JA, Asaria P, Francis DP. Mortality from ischaemic heart disease by country, region, and age: statistics from World Health Organisation and United Nations. Int J Cardiol 2013;168:934-945.
8. Tunstall-Pedoe H, Vanuzzo D, Hobbs M, Mähönen M, Cepaitis Z, Kuulasmaa K, Keil U. Estimation of contribution of changes in coronary care to improving survival, event rates, and coronary heart disease mortality across the WHO MONICA Project populations. Lancet 2000;355:688-700.
9. Yusuf S, Islam S, Chow CK, Rangarajan S, Dagenais G, Diaz R, Gupta R, Kelishadi R, Iqbal R, Avezum A, Kruger A, Kutty R, Lanas F, Lisheng L, Wei L, Lopez-Jaramillo P, Oguz A, Rahman O, Swidan H, Yusoff K, Zatonski W, Rosengren A, Teo KK; Prospective Urban Rural Epidemiology (PURE) Study Investigators. Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low-income countries (the PURE Study): a prospective epidemiological survey. Lancet 2011;378:1231-1243.
10. Chandrashekhar Y, Alexander T, Mullasari A, Kumbhani DJ, Alam S, Alexanderson E, Bachani D, Wilhelmus Badenhorst JC, Baliga R, Bax JJ, Bhatt DL, Bossone E, Botelho R, Chakraborthy RN, Chazal RA, Dhaliwal RS, Gamra H, Harikrishnan SP, Jeilan M, Kettles DI, Mehta S, Mohanan PP, Kurt Naber C, Naik N, Ntsekhe M, Otieno HA, Pais P, Piñeiro DJ, Prabhakaran D, Reddy KS, Redha M, Roy A, Sharma M, Shor R, Adriaan Snyders F, Weii Chieh Tan J, Valentine CM, Wilson BH, Yusuf S, Narula J. Resource and infrastructure-appropriate management of ST-segment elevation myocardial infarction in low- and middle-income countries. Circulation 2020;141:2004-2025.
11. Statistical Centre of Iran. Estimation of population in Iran by province and year. https://rb.gy/vgedij (1 January 2021).
12. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD; Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol 2018;72:2231-2264.
13. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J; CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150:604-612.
14. Greenland S, Pearce N. Statistical foundations for model-based adjustments. Annu Rev Public Health 2015;36:89-108.
15. Kassaian SE, Masoudkabir F, Sezavar H, Mohammadi M, Pourmoghaddas A, Kojuri J, Ghaffari S, Sanaati H, Alaeddini F, Pourmirza B, Mir E; IPACE2 Registry Investigators. Clinical characteristics, management and 1-year outcomes of patients with acute coronary syndrome in Iran: the Iranian Project for Assessment of Coronary Events 2 (IPACE2). BMJ Open 2015;5:e007786.
16. Xavier D, Pais P, Devereaux PJ, Xie C, Prabhakaran D, Reddy KS, Gupta R, Joshi P, Kerkar P, Thanikachalam S, Haridas KK, Jaison TM, Naik S, Maity AK, Yusuf S; CREATE registry investigators. Treatment and outcomes of acute coronary syndromes in India (CREATE): a prospective analysis of registry data. Lancet 2008;371:1435-1442.
17. Huo X, Khera R, Zhang L, Herrin J, Bai X, Wang Q, Lu Y, Nasir K, Hu S, Li J, Li X, Zheng X, Masoudi FA, Spertus JA, Krumholz HM, Jiang L. Education level and outcomes after acute myocardial infarction in China. Heart 2019;105:946-952.
18. Yusuf S, Joseph P, Rangarajan S, Islam S, Mente A, Hystad P, Brauer M, Kutty VR, Gupta R, Wielgosz A, AlHabib KF, Dans A, Lopez-Jaramillo P, Avezum A, Lanas F, Oguz A, Kruger IM, Diaz R, Yusoff K, Mony P, Chifamba J, Yeates K, Kelishadi R, Yusufali A, Khatib R, Rahman O, Zatonska K, Iqbal R, Wei L, Bo H, Rosengren A, Kaur M, Mohan V, Lear SA, Teo KK, Leong D, O'Donnell M, McKee M, Dagenais G. Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. Lancet 2020;395:795-808.
19. Kubota Y, Heiss G, MacLehose RF, Roetker NS, Folsom AR. Association of educational attainment with lifetime risk of cardiovascular disease: the atherosclerosis risk in communities study. JAMA Intern Med 2017;177:1165-1172.
20. Schultz WM, Kelli HM, Lisko JC, Varghese T, Shen J, Sandesara P, Quyyumi AA, Taylor HA, Gulati M, Harold JG, Mieres JH, Ferdinand KC, Mensah GA, Sperling LS. Socioeconomic status and cardiovascular outcomes: challenges and interventions. Circulation 2018;137:2166-2178.
21. Dennison CR, McEntee ML, Samuel L, Johnson BJ, Rotman S, Kielty A, Russell SD. Adequate health literacy is associated with higher heart failure knowledge and self-care confidence in hospitalized patients. J Cardiovasc Nurs 2011;26:359-367.
22. Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol 2009;53:1925-1932.
23. Rana JS, Mukamal KJ, Morgan JP, Muller JE, Mittleman MA. Obesity and the risk of death after acute myocardial infarction. Am Heart J 2004;147:841-846.
24. Nigam A, Wright RS, Allison TG, Williams BA, Kopecky SL, Reeder GS, Murphy JG, Jaffe AS. Excess weight at time of presentation of myocardial infarction is associated with lower initial mortality risks but higher long-term risks including recurrent re-infarction and cardiac death. Int J Cardiol 2006;110:153-159.
25. Plakht Y, Shiyovich A, Weitzman S, Fraser D, Zahger D, Gilutz H. A new risk score predicting 1- and 5-year mortality following acute myocardial infarction Soroka Acute Myocardial Infarction (SAMI) project. Int J Cardiol 2012;154:173-179.
26. Nalini M, Sharafkhah M, Poustchi H, Sepanlou SG, Pourshams A, Radmard AR, Khoshnia M, Gharavi A, Dawsey SM, Abnet CC, Boffetta P, Brennan P, Sotoudeh M, Nikmanesh A, Merat S, Etemadi A, Shakeri R, Malekzadeh R, Kamangar F. Comparing anthropometric indicators of visceral and general adiposity as determinants of overall and cardiovascular mortality. Arch Iran Med 2019;22:301-309.
27. Fazel R, Joseph TI, Sankardas MA, Pinto DS, Yeh RW, Kumbhani DJ, Nallamothu BK. Comparison of reperfusion strategies for ST-segment-elevation myocardial infarction: a multivariate network meta-analysis. J Am Heart Assoc 2020;9:e015186.
28. Sim DS, Jeong MH, Ahn Y, Kim YJ, Chae SC, Hong TJ, Seong IW, Chae JK, Kim CJ, Cho MC, Rha SW, Bae JH, Seung KB, Park SJ; Korea Acute Myocardial Infarction Registry (KAMIR) Investigators. Pharmacoinvasive strategy versus primary percutaneous coronary intervention in patients with ST-segment-elevation myocardial infarction: a propensity score-matched analysis. Circ Cardiovasc Interv 2016;9:e003508.
29. Huber K, Goldstein P, Danchin N, Fox KA, Welsh R, Granger CB, Henry T, Gersh BJ. Enhancing the efficacy of delivering reperfusion therapy: a European and North American experience with ST-segment elevation myocardial infarction networks. Am Heart J 2013;165:123-132.
30. Salehi N, Motevaseli S, Janjani P, Bahremand M, Heidari Moghadam R, Rouzbahani M, Siabani S, Tadbiri H, Nalini M. Reperfusion therapy and predictors of 30-day mortality after ST-segment elevation myocardial infarction in a university medical center in western Iran. Arch Iran Med 2021;24:796-803.
31. Sarnak MJ, Amann K, Bangalore S, Cavalcante JL, Charytan DM, Craig JC, Gill JS, Hlatky MA, Jardine AG, Landmesser U, Newby LK, Herzog CA, Cheung M, Wheeler DC, Winkelmayer WC, Marwick TH; Conference Participants. Chronic kidney disease and coronary artery disease: JACC state-of-the-art review. J Am Coll Cardiol 2019;74:1823-1838.
| Files | ||
| Issue | Vol 17 No 2 (2022): J Teh Univ Heart Ctr | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jthc.v17i2.9839 | |
| Keywords | ||
| Myocardial infarction Mortality Morbidity Risk Factors Stroke | ||
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How to Cite
1.
Janjani P, Motevaseli S, Salehi N, Heidari Moghadam R, Siabani S, Nalini M. Predictors of 1-Year Major Cardiovascular Events after ST-Elevation Myocardial Infarction in a Specialized Cardiovascular Center in Western Iran. J Tehran Heart Cent. 2022;17(2):62-70.
