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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Predictors of mortality in patients with non-anterior ST-segment elevation myocardial infarction: Analysis from the
Xin Huang1,2, Björn Redfors1,3, Shmuel Chen1
1Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
Insights
Identifying predictors of 3-year mortality in non-anterior ST-elevation myocardial infarction (NA-STEMI) after percutaneous coronary intervention (PCI) is crucial. Older age, diabetes, reduced LVEF, higher Killip class, poor TIMI flow, renal insufficiency, and low ST-resolution predict worse outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Prognosis uncertainty for patients with non-anterior ST-elevation myocardial infarction (NA-STEMI) undergoing percutaneous coronary intervention (PCI).
- Need to identify high-risk patient cohorts within NA-STEMI for targeted management.
Purpose of the Study:
- To identify clinical, electrocardiographic (ECG), and angiographic predictors of 3-year mortality in NA-STEMI patients post-primary PCI.
- To stratify risk within the NA-STEMI population based on identified predictors.
Main Methods:
- Analysis of data from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial.
- Definition of NA-STEMI based on specific ECG lead criteria.
- Application of Cox regression analysis to determine independent predictors of 3-year mortality, with multiple imputation for missing data.
Main Results:
- NA-STEMI patients (n=1,495) had lower 3-year mortality (4.5%) compared to anterior STEMI (7.1%).
- Independent predictors of increased 3-year mortality in NA-STEMI included older age, diabetes, reduced LVEF (≤50%), Killip class ≥2, post-PCI TIMI flow 0-2, renal insufficiency, and ST-resolution <30% at 60 min.
- A risk score based on these factors showed significantly increasing mortality with more risk factors (1.8% for 0 factors to 36.3% for ≥4 factors).
Conclusions:
- Non-anterior STEMI generally carries a better prognosis than anterior STEMI.
- Specific high-risk subgroups within NA-STEMI can be identified, exhibiting substantial 3-year mortality.
- These findings aid in risk stratification and potentially personalized treatment strategies for NA-STEMI patients.
Objectives:
We sought to identify clinical, electrocardiographic (ECG), and angiographic characteristics that are predictive of 3-year mortality after primary percutaneous coronary intervention (PCI) in patients with non-anterior ST-elevation myocardial infarction (NA-STEMI) from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial.
Background:
Which patients with NA-STEMI undergoing PCI have a poor prognosis is uncertain.
Methods:
NA-STEMI was defined as ST-segment elevation in lateral (V5, V6, I, aVL), inferior (II, III, aVF), or inferolateral (I, II, III, aVF, and V5-V6) ECG leads or posterior myocardial infarction with ST-segment depression of ≥1 mm in ≥2 contiguous anterior leads. Cox regression was used to identify independent predictors of 3-year mortality. Missing data were imputed using multiple imputation.
Results:
In HORIZONS-AMI, 2,578/3,602 patients had no prior coronary artery bypass grafting, underwent single-vessel PCI, and had baseline ECG data assessed in an independent core laboratory. Among them, 1,495 (58.0%) had NA-STEMI. Patients with NA-STEMI had lower 3-year mortality risk than those with anterior STEMI (4.5% versus 7.1%, P = 0.004). The independent predictors of increased 3-year mortality in NA-STEMI were older age (median > 59.0 years), diabetes, reduced LVEF (≤50%), Killip class ≥2, post-procedure TIMI flow 0-2 versus 3, renal insufficiency, and ST-resolution <30% at 60 min post-PCI. Patients with 0, 1, 2, 3, and ≥4 of these risk factors had 3-year mortality rates of 1.8%, 2.3%, 3.1%, 6.1%, and 36.3%, respectively (P < 0.0001).
Conclusions:
Although NA-STEMI carries a better prognosis than anterior STEMI, high-risk patient cohorts with NA-STEMI may be identified who have substantial 3-year mortality.
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