Related Experiment Videos
Predictors of 30-day and 1-year mortality after primary percutaneous coronary intervention for ST-elevation
Saman Rasoul1, Jan Paul Ottervanger, Menko-Jan de Boer
1Isala Klinieken, Locatie Weezenlanden, Department of Cardiology, Zwolle, The Netherlands.
Insights
Predictors of early and late mortality after ST-elevation myocardial infarction (STEMI) differ. While some factors like diabetes predict both 30-day and 1-year death, others like multivessel disease are specific to early mortality.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Predictors of mortality following ST-elevation myocardial infarction (STEMI) can vary significantly between early (30-day) and late (1-year) post-treatment phases.
- Understanding these distinct predictors is crucial for optimizing patient management and improving long-term survival after primary percutaneous coronary intervention (PCI).
Purpose of the Study:
- To identify and compare the predictors of 30-day and 1-year mortality in a large cohort of unselected patients with STEMI treated with primary PCI.
- To determine if factors influencing early mortality differ from those impacting mortality beyond the acute phase.
Main Methods:
- Prospective data collection from 4732 patients with STEMI undergoing primary PCI over an 11-year period.
- Analysis of patient characteristics, 30-day mortality, and 1-year mortality among 30-day survivors.
- Age and sex-adjusted multivariate analysis to identify significant predictors for both time points.
Main Results:
- Overall 30-day mortality was 4.6%, with an additional 2.8% mortality among 30-day survivors by 1 year.
- Older age, higher risk profiles, Killip class >2, multivessel disease, and lower left ventricular ejection fraction were associated with increased mortality.
- Predictors for both 30-day and 1-year mortality included previous myocardial infarction, diabetes, Killip class >2, poor post-PCI flow, and LVEF <30%.
- Multivessel disease, anterior infarct location, in-hospital reinfarction, and longer ischemic times were particularly strong predictors of 30-day mortality.
Conclusions:
- While many mortality predictors are shared between the 30-day and 1-year post-STEMI periods, distinct factors significantly influence early versus later outcomes.
- These findings highlight the need for tailored risk stratification and management strategies that address both acute and long-term risks in STEMI patients.
Objective:
Predictors of 30-day mortality may differ from predictors of mortality at 1 year among 30-day survivors of ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). We aimed to evaluate the predictors of 30-day and 1-year mortality in unselected patients with STEMI treated with PCI.
Methods:
Individual patient data from 4732 patients with STEMI, who were treated with primary PCI during an 11-year study period, were recorded prospectively. Patient characteristics, 30-day, and 1-year outcome were evaluated.
Results:
At 30-day follow-up, 219 patients (4.6%) died; and out of the 4513 30-day survivors, 109 patients (2.8%) died at 1 year. Patients who died were older, had a higher risk profile. Higher rates of Killip class greater than 2 on admission, multivessel disease, and, more often, lower left ventricular ejection fraction were observed in patients who died. Mortality rate was 7.6% at 30 days among the females when compared with 3.7 among the males, P value less than 0.001. Age and sex-adjusted multivariate analysis revealed that previous myocardial infarction, diabetes, Killip class greater than 2, post-PCI thrombolysis in myocardial infarction flow less than 3, and left ventricular ejection fraction less than 30% were strong predictors of both 30-day and 1-year mortality. However, multivessel disease, anterior myocardial infarct location and in-hospital reinfarction, ischemic time, and pre-PCI thrombolysis in myocardial infarction flow less than 3 were particularly strong predictors of 30-day mortality.
Conclusion:
Despite the fact that most characteristics of 30-day and 1-year mortality among 30-day survivors are similar, we found that variables that affect mortality beyond the acute phase may not necessarily be the same as those that influence early mortality.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:27Coronary Artery Disease V: Interprofessional Care