In-hospital mortality after acute STEMI in patients undergoing primary PCI
M Ali1,2, S A Lange3,4, T Wittlinger3
1Department of Cardiology, heart catheterization laboratory, Asklepios Harzklinik Goslar, Kösliner Straße 12, 38642, Goslar, Germany. dr-mali@hotmail.de.
Insights
In ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI), culprit lesions in the left main coronary artery (LMCA) and ramus circumflexus (RCX) are linked to higher in-hospital mortality. This highlights LMCA and RCX involvement as potential novel risk factors.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Acute myocardial infarction (AMI) is a leading cause of mortality globally.
- ST-segment elevation myocardial infarction (STEMI) requires prompt intervention.
- Primary percutaneous coronary intervention (pPCI) is a standard treatment for STEMI.
Purpose of the Study:
- To investigate the association between the specific coronary artery involved and in-hospital mortality in STEMI patients treated with pPCI.
- To identify novel risk factors for mortality in this patient cohort.
Main Methods:
- Retrospective analysis of 312 STEMI patients undergoing pPCI between 2013 and 2017.
- Assessment of in-hospital mortality and its correlation with demographic, clinical, and angiographic factors.
- Study conducted at a single center without immediate access to mechanical circulatory support (MCS).
Main Results:
- In-hospital mortality was 10% (31 patients).
- Mortality was associated with pre-hospital cardiopulmonary resuscitation (CPR), older age, lower systolic blood pressure, higher Killip class, triple-vessel disease, female gender, and culprit lesions in the left main coronary artery (LMCA) and ramus circumflexus (RCX).
- LMCA and RCX culprit lesions showed a significant association with in-hospital mortality (p=0.0083 and p=0.0141, respectively).
Conclusions:
- Culprit lesions in the LMCA and RCX are associated with significantly higher in-hospital mortality in STEMI patients after pPCI.
- These findings suggest LMCA and RCX involvement may represent novel risk factors for STEMI-related mortality.
- The study underscores the importance of considering MCS availability in pPCI centers, especially for patients requiring CPR.
Background:
Acute myocardial infarction (AMI) is the main cause of global and in-hospital mortality in patients with cardiovascular diseases. We aimed to examine the association between the coronary artery involved and the in-hospital mortality in patients who underwent primary percutaneous coronary intervention (pPCI) after ST segment elevation myocardial infarction (STEMI).
Methods:
The in-hospital mortality of STEMI patients who underwent pPCI was assessed at the Department of Cardiology, Harzklinik Goslar, Germany, which has no access to immediate mechanical circulatory support (MCS), between 2013 and 2017.
Results:
We enrolled 312 STEMI patients, with a mean age of 67.1 ± 13.4 years, of whom 211 (68%) were male. In-hospital mortality was documented in 31 patients (10%). In-hospital mortality was associated with pre-hospital cardiopulmonary resuscitation (CPR; n = 39/12.5%), older age, lower systolic blood pressure, Killip class > 1, triple-vessel disease (each p < 0.0001), female gender (p = 0.0158), and with the localization of the treated culprit lesion in the left main coronary artery (LMCA; p = 0.0083) and in the ramus circumflexus (RCX; p = 0.0141).
Conclusion:
In this monocentric cohort, all-cause in-hospital mortality of STEMI patients after pPCI was significantly higher in those patients with culprit lesions in the LMCA and in the RCX, which may prove to be a substantial novel risk factor for STEMI-related mortality. Increasing age and female gender may be interdependent risk factors for mortality in this patient population. Furthermore, our data highlight the importance of the availability of MCS options in pPCI centers for patients after CPR.
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