Prevalence and predictors associated with in-hospital mortality in acute ST segment elevation myocardial infarction
Chorchana Wichian1, Thotsaporn Morasert2, Thanapon Nilmoje3
1Cardiology Unit, Department of Internal medicine, Suratthani Hospital, Suratthani, Thailand.
Insights
In-hospital mortality in ST-segment elevation myocardial infarction (STEMI) patients receiving reperfusion therapy is linked to lower left ventricular ejection fraction (LVEF) and cardiac arrest at presentation. These factors are key predictors for STEMI outcomes in developing countries.
Area of Science:
- Cardiology
- Internal Medicine
- Public Health
Background:
- In-hospital mortality predictors for ST-segment elevation myocardial infarction (STEMI) post-reperfusion therapy in developing nations remain unclear.
- Understanding these predictors is crucial for improving patient outcomes in resource-limited settings.
Purpose of the Study:
- To investigate the prevalence and predictors of in-hospital mortality among STEMI patients undergoing reperfusion therapy.
- To identify factors associated with mortality in a developing country context.
Main Methods:
- Retrospective cohort study of 431 acute STEMI patients at Suratthani Hospital (October 2015 - September 2017).
- Analysis of reperfusion therapy (fibrinolytic or primary PCI) and in-hospital outcomes.
- Statistical adjustment for baseline variables to identify independent predictors of mortality.
Main Results:
- 32 patients (7.4%) died during hospitalization.
- Higher prevalence of chronic kidney disease, anterior wall MI, cardiogenic shock, and cardiac arrest in non-survivors.
- Lower left ventricular ejection fraction (LVEF) and cardiac arrest at presentation were independently associated with increased in-hospital mortality.
Conclusions:
- Left ventricular ejection fraction (LVEF) and cardiac arrest at presentation are significant independent predictors of in-hospital mortality in STEMI patients.
- Findings highlight the importance of assessing LVEF and managing cardiac arrest in STEMI patients receiving reperfusion therapy.
Background:
The prevalence and predictors of in-hospital mortality in the unselected patients with ST-segment elevation myocardial infarction (STEMI) after reperfusion therapy with fibrinolytic or primary percutaneous coronary intervention (PCI) in developing country have not well established.
Methods:
We conducted a retrospective cohort study design. All admission records of acute ST elevation myocardial infarction at Suratthani Hospital between October 2015 and September 2017.
Results:
The finding between October 2015 and September 2017, a total of 431 patients received reperfusion therapy and were included in the present study. Majority of the patient were male (80.5%), almost half of the population had anterior wall MI, 32 patients died (7.4%), and 399 survived during the index hospitalization. The prevalence of chronic kidney disease, anterior wall MI, cardiogenic shock and cardiac arrest in non-survived group was higher than the survived group. Echocardiogram was performed in 299 patient (69.4%) and the median left ventricular ejection fraction (LVEF) in overall population was 51%. After adjustment for baseline variables, LVEF (aOR 0.91, 95% CI, 0.83-0.98, P=0.02) and cardiac arrest at presentation (aOR 22, 95% CI, 1.22-410.05, P=0.036) were independently associated with in-hospital mortality.
Conclusions:
LVEF and cardiac arrest at presentation were independently associated with in-hospital mortality in STEMI patients receiving reperfusion therapy either fibrinolytic therapy or primary PCI.
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