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Prediction of one-year mortality among 30-day survivors after primary percutaneous coronary interventions
Rajendra H Mehta1, William W O'neill, Kishore J Harjai
1Duke Clinical Research Institute, Durham, North Carolina, USA. mehta007@dcri.duke.edu
Insights
Older age, lower weight, and heart rhythm issues increase 1-year mortality risk for ST-elevation myocardial infarction (STEMI) survivors treated with primary percutaneous coronary intervention (PCI). Identifying these factors aids long-term prognosis planning.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Limited data exists on 1-year mortality risk factors in ST-elevation myocardial infarction (STEMI) patients surviving the initial 30 days post-primary percutaneous coronary intervention (PCI).
- Understanding long-term prognosis is crucial for patient counseling and healthcare planning.
Purpose of the Study:
- To identify clinical and angiographic features associated with 1-year mortality among STEMI patients who survived >30 days after primary PCI.
- To provide clinicians with a tool for assessing long-term risk in this patient population.
Main Methods:
- Analysis of 3,280 patients from the Stent-PAMI and CADILLAC trials who underwent primary PCI for STEMI and survived >30 days.
- Multivariate logistic regression to identify independent predictors of 1-year death.
Main Results:
- 74 patients (2.3%) died within 1 year of surviving >30 days post-STEMI.
- Independent predictors of 1-year mortality included age >70 years, weight <80 kg, tachyarrhythmia during hospitalization, number of diseased coronary arteries, and lower left ventricular ejection fraction.
Conclusions:
- Age, weight, tachyarrhythmia, coronary artery disease extent, and left ventricular ejection fraction are significant independent predictors of 1-year mortality in STEMI survivors post-primary PCI.
- These findings enable better clinical risk stratification and patient expectation management for long-term outcomes.
Abstract:
Little information exists on the features that influence risk factors for death at 1 year among 30-day survivors of ST-elevation myocardial infarction (STEMI) that is treated with primary percutaneous coronary intervention (PCI). Accordingly, we examined 3,280 patients with STEMI who were enrolled in Stent-PAMI and CADILLAC trials, were treated with primary PCI, and survived >30 days after STEMI. Death at 1 year occurred in 74 patients (2.3%) who survived >30 days after their index STEMI. Patients who died at 1 year were more likely to be older and women and have lower body weight and greater prevalence of previous stroke. Similarly, the sum of ST elevations, 3-vessel or left anterior coronary disease, and final Thrombolysis In Myocardial Infarction grade <3 flow was higher, whereas left ventricular ejection fraction was lower among patients who died versus those who survived. The multivariate logistic regression model identified age >70 years (odds ratio [OR] 3.3 95% confidence interval [CI] 1.9 to 5.7), weight <80 kg (OR 1.9, 95% CI 1.1 to 3.6), any tachyarrhythmia during index hospitalization (defined as ventricular or supraventricular tachycardia that required treatment) (OR 2.4, 95% CI 1.2 to 4.8), number of diseased coronary arteries (OR 1.5, 95% CI 1.1 to 2.1), and left ventricular ejection fraction (each 10% decrease, OR 1.5, 95% CI 1.2 to 1.8) as factors independently associated with risk of death at 1 year among 30-day survivors. In conclusion, our study provides a method for clinicians to advise patients who are treated with primary PCI and survive the acute phase of STEMI with regard to patients' long-term prognosis, thus enhancing planning and setting up of realistic expectations.
