Mortality in patients with ST-segment elevation myocardial infarction who do not undergo reperfusion

Area of Science:

• Cardiology
• Interventional Cardiology
• Acute Coronary Syndromes

Background:

• Reperfusion therapy significantly reduces mortality in ST-segment elevation myocardial infarctions (STEMI).
• However, a subset of STEMI patients do not receive reperfusion therapy (thrombolysis or primary percutaneous coronary intervention).
• The decision-making process and clinical outcomes for these non-reperfusion STEMI patients are not well-characterized.

Purpose of the Study:

• To describe the characteristics, reasons for non-reperfusion, management, and outcomes of STEMI patients who did not undergo reperfusion therapy.
• To identify factors associated with mortality in this specific patient cohort.

Main Methods:

• Retrospective chart review of 139 STEMI patients who did not receive reperfusion therapy.
• Data collected from October 2006 to March 2011 at a high-volume percutaneous coronary intervention center.
• Analysis included clinical data, reasons for no reperfusion, management strategies, and in-hospital and 1-year mortality.

Main Results:

• The study included 139 STEMI patients (mean age 80±13 years; 61% women) who did not receive reperfusion therapy.
• Common reasons for no reperfusion included advanced age, comorbidities, kidney injury, delayed presentation, advance directives, patient preference, and dementia; 60% had ≥3 reasons.
• In-hospital mortality was 53%, and 1-year mortality was 69%. Cardiogenic shock, intubation, and advance directives were associated with higher mortality.

Conclusions:

• In a high-volume PCI center, STEMI patients not receiving reperfusion therapy often have multiple contributing factors for this decision, with advanced age being most common.
• This population experiences significantly high mortality rates, with less than half surviving hospitalization.
• Further research may be needed to optimize care for this high-risk STEMI subgroup.