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Predictors of survival in unselected patients with acute myocardial infarction requiring continuous catecholamine
Wolfgang Schreiber1, Harald Herkner, Maria Koreny
1Department of Emergency Medicine, University Hospital of Vienna, AKH, Waehringer Guertel 18-20/6D, A-1090 Wien, Austria. wolfgang.schreiber@akh-wien.ac.at
Insights
For acute myocardial infarction patients needing catecholamine support, younger age, no adrenaline use, and lower peak CKMB levels predict better survival. These factors are key for improving outcomes in this critical patient group.
Area of Science:
- Cardiology
- Critical Care Medicine
Background:
- Limited data exists on survival predictors for unselected acute myocardial infarction (AMI) patients with cardiogenic shock, especially those with out-of-hospital cardiac arrest.
- This study addresses the gap by examining an unselected cohort representative of real-world clinical practice.
Purpose of the Study:
- To identify predictors of in-hospital survival in unselected patients with AMI requiring continuous catecholamine support for circulatory failure.
- To provide insights into managing complex AMI cases, including those with prior cardiac arrest.
Main Methods:
- Retrospective cohort study of 262 consecutive AMI patients requiring catecholamine support within 24 hours of admission.
- Data collected prospectively from 1993 to 2000 at a university hospital.
- Primary endpoint: in-hospital mortality. Multivariate analysis used to identify independent predictors.
Main Results:
- In-hospital mortality was 53% (138/262).
- Survivors were significantly younger (60 vs. 68 years) and had lower peak CKMB levels (93 vs. 138 U/l) compared to non-survivors.
- Independent predictors of survival included younger age, absence of adrenaline (epinephrine) administration, and lower peak CKMB levels.
Conclusions:
- In unselected AMI patients requiring catecholamine support, younger age, no continuous adrenaline use, and lower peak CKMB are independently associated with increased in-hospital survival.
- These findings are crucial for risk stratification and treatment decisions in critically ill AMI patients.
Background:
Several predictors of survival have been described in selected subgroups of patients suffering from acute myocardial infarction. However, data on unselected patients with acute myocardial infarction and cardiogenic shock, including patients with out-of hospital cardiac arrest, are missing. We aimed to assess predictors of survival for an unselected cohort of patients representative of clinical practice who experienced acute myocardial infarction and required continuous catecholamine support for circulatory failure.
Methods:
The study was performed at a 2000 bed university hospital. All consecutive patients admitted to our emergency department with acute myocardial infarction were prospectively enrolled in a clinical trial from 1993 to 2000.
Design:
A retrospective cohort study was performed on patients with myocardial infarction requiring catecholamine support within the first 24 h. Primary endpoint was in-hospital mortality.
Results:
The analysis was carried out on 262 patients, 189 men (72%), median age 65 years (IQR 53-73). Out-of-hospital cardiac arrest was reported in 47% (122/262). In-hospital mortality was 53% (138/262). Survivors as compared to non-survivors exhibited significant differences with respect to age (60 vs. 68 years, P<0.0001), systolic and diastolic blood pressure on admission (110 vs. 102 mmHg, P=0.01 and 64 vs. 58 mmHg, P=0.006, respectively), initial blood serum lactate (6.8 vs. 8.3, P=0.01), peak CKMB level (93 vs. 138 U/l, P=0.005), use of adrenaline (epinephrine) (38 vs. 68%, P<0.0001) and any attempt of revascularisation (76 vs. 63%, P=0.03). In a multivariate model younger age [OR 1.06 (CI 1.03-1.10), P<0.001], no use of adrenaline [OR 2.63 (CI 1.35-5.26) P=0.005] and lower peak CKMB [OR 1.01 (CI 1.01-1.01), P<0.0001] were independently associated with in-hospital survival.
Conclusion:
In unselected patients including CPR survivors with acute myocardial infarction requiring continuous catecholamine support, younger age, the absence of continuous adrenaline administration and a lower peak CKMB were independently associated with increased in-hospital survival.