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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Post percutaneous coronary intervention hemoglobin levels predict in-hospital mortality in patients with STEMI
Gönül Zeren1, İlhan İlker Avcı1, Barış Şimşek1
1Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital; İstanbul-Turkey.
Insights
Post-percutaneous coronary intervention (PCI) hemoglobin levels at 24 hours are a stronger predictor of in-hospital mortality in ST-elevation myocardial infarction (STEMI) patients than admission hemoglobin. This finding is crucial for risk stratification after primary PCI.
Area of Science:
- Cardiovascular Medicine
- Clinical Cardiology
- Critical Care Medicine
Background:
- ST-elevation myocardial infarction (STEMI) is a critical condition requiring urgent reperfusion therapy.
- Predictors of in-hospital mortality in STEMI patients undergoing primary percutaneous coronary intervention (PCI) are vital for patient management.
- The role of hemoglobin levels in predicting outcomes after PCI in STEMI patients without bleeding remains an area of investigation.
Purpose of the Study:
- To evaluate whether admission hemoglobin or post-percutaneous coronary intervention (PCI) hemoglobin levels at 24 hours predict in-hospital mortality.
- To compare the predictive importance of admission versus post-PCI hemoglobin for mortality in STEMI patients undergoing primary PCI without hemorrhage.
Main Methods:
- A cohort of 1,444 consecutive STEMI patients who underwent primary PCI was analyzed.
- In-hospital all-cause mortality was the primary outcome.
- Penalized maximum likelihood estimation (PMLE) logistic regression was employed to identify predictors of mortality.
Main Results:
- In-hospital mortality occurred in 172 (11.9%) patients.
- Post-PCI hemoglobin levels at 24 hours were identified as a significant predictor of in-hospital mortality.
- Post-PCI hemoglobin at 24 hours (6% contribution) was a substantially stronger predictor than admission hemoglobin (0.1% contribution).
Conclusions:
- Post-percutaneous coronary intervention (PCI) hemoglobin levels are independently associated with in-hospital survival in STEMI patients without bleeding.
- Hemoglobin levels measured 24 hours post-PCI are a more effective predictor of in-hospital mortality than admission hemoglobin levels in this patient group.
Objective:
In this study, we aimed to determine whether admission hemoglobin versus post-percutaneous coronary intervention (PCI) hemoglobin level at 24 hours is a predictor of in-hospital mortality for patients with ST elevation myocardial infarction (STEMI) without evidence of clinical hemorrhage who underwent primary PCI.
Methods:
In this study, we included 1,444 consecutive patients with STEMI who underwent primary PCI at a tertiary heart hospital. The primary outcome of the study was the in-hospital all-cause mortality. We used the penalized maximum likelihood estimation (PMLE) logistic regression method to examine the relationship between primary outcome and candidate predictors.
Results:
In total, 172 (11.9%) patients died during the in-hospital course. According to a PMLE logistic regression analysis, age, KILLIP class ≥2, pre-PCI thrombolysis in myocardial infarction (TIMI) flow <3, systolic blood pressure, creatinine, glycoprotein IIb/IIIa inhibitor use, and post-PCI hemoglobin levels at 24 hours were predictors of in-hospital mortality. The relative importance of post-PCI hemoglobin at 24 hours (contributing 6% of the explainable outcome in the model) was significantly higher than admission hemoglobin (contributing only 0.1% of the explainable outcome in the model).
Conclusion:
This study demonstrated that post-PCI hemoglobin levels were independently associated with in-hospital survival in patients with STEMI without evidence of bleeding following primary PCI. In addition, post-PCI hemoglobin was a better predictor of in-hospital mortality than admission hemoglobin for patients with STEMI who underwent primary PCI.
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