Risk factors for in-hospital death in acute ST-segment elevation myocardial infarction after emergency percutaneous
1School of Graduate, Hebei Medical University, Shijiazhuang, China; Department of Cardiology, Baoding No. 1 Central Hospital, Baoding, China.
Insights
Female sex, higher Killip class, left main coronary artery lesions, and longer symptom onset-to-balloon times predict in-hospital death after percutaneous coronary intervention for ST-segment elevation myocardial infarction. Protective factors include beta-blockers, ACE inhibitors/ARBs, higher BMI, and better ejection fraction.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Research
Background:
- ST-segment elevation myocardial infarction (STEMI) carries a significant risk of in-hospital mortality, even post-percutaneous coronary intervention (PCI).
- Identifying predictors of mortality is crucial for improving outcomes in STEMI patients undergoing emergency PCI.
Purpose of the Study:
- To identify clinical and procedural predictors of in-hospital mortality in patients with acute ST-segment elevation myocardial infarction (STEMI) following emergency percutaneous coronary intervention (PCI).
Main Methods:
- Retrospective analysis of 1,169 STEMI patients undergoing emergency PCI between 2016-2018.
- Data collected included general, medical history, clinical, and medication details.
- Multivariate logistic regression was used to identify risk and protective factors for in-hospital mortality.
Main Results:
- In-hospital mortality was 8.13% (95 patients).
- Risk factors for mortality included female sex, higher Killip class (2 and 4), left main coronary artery lesions, final TIMI flow of 1 or 2, longer symptom onset-to-door time (SDT), longer symptom onset-to-balloon time (SBT), and higher SYNTAX score.
- Protective factors included higher BMI, greater ejection fraction, lower LDL-cholesterol, and postoperative use of beta-blockers and ACE inhibitors/ARBs.
Conclusions:
- Female sex, Killip grade, left main lesions, TIMI grade, SDT, SBT, and SYNTAX score are associated with increased in-hospital death risk post-PCI for STEMI.
- Conversely, higher BMI, ejection fraction, LDL-C levels, and use of beta-blockers and ACEI/ARBs are associated with reduced in-hospital death risk.
Background:
For some acute ST-segment elevation myocardial infarction (STEMI) cases, the risk of in-hospital death remains high even after emergency percutaneous coronary intervention (PCI). This study sought to identify predictors of in-hospital mortality in STEMI patients after PCI.
Methods:
Patients with acute STEMI, who underwent emergency PCI at Hebei General Hospital, Baoding First Central Hospital, and Cangzhou Central Hospital, from January 2016 to December 2018, were retrospectively included in this study. The patients' general data, previous medical history, clinical data and medication data were collected and compared between the survival and mortality groups. The primary outcome was in-hospital mortality. In-hospital mortality was defined as all-cause death during admission.
Results:
Of the 1,169 patients (876 male and 293 female) enrolled in this study, 95 (8.13%) died during hospitalization. The multivariate logistic regression analysis showed that being female [odds ratio (OR) =5.86, 95% confidence interval (CI): 2.03-16.92, P=0.001], a Killip class of 2 (OR =8.13, 95% CI: 2.03-32.61, P=0.003), a Killip class of 4 (OR =17.31, 95% CI: 3.69-81.27, P=0.001), a left main coronary artery lesion (OR =44.25, 95% CI: 3.96-494.05, P=0.002), a final TIMI flow of 1 (OR =171.83, 95% CI: 28.46-1037.51, P=0.001), a final TIMI flow of 2 (OR =72.93, 95% CI: 38.54-138.00, P=0.001), symptom onset-to-door time (SDT) (OR =1.01, 95% CI: 1.00-1.02, P=0.001), symptom onset-to-balloon dilatation time (SBT) (OR =1.01, 95% CI: 1.00-1.02, P=0.001), and the Synergy Between PCI With Taxus and CABG (SYNTAX) score (OR =1.07, 95% CI: 1.01-1.12, P=0.019) were risk factors; while postoperative β-receptor blockers (OR =0.10, 95% CI: 0.03-0.30, P=0.001) postoperative angiotensin-converting enzymes/angiotensin receptor blockers (OR =0.13, 95% CI: 0.04-0.44, P=0.001), BMI (OR =0.85, 95% CI: 0.74-0.98, P=0.024), the percentage of the ejection fraction (OR =0.81, 95% CI: 0.75-0.86, P=0.001), and low-density lipoprotein cholesterol (OR =0.44, 95% CI: 0.21-0.91, P=0.027) were protective factors for in-hospital mortality.
Conclusions:
Female, Killip grade, a left main lesion, TIMI grade, SDT, SBT, and SYNTAX score were associated with a higher risk of in-hospital death. Conversely, BMI, ejection fraction, LDL-C level, and postoperative use of β-blocker and ACEI/ARB drugs were associated with a lower in-hospital death risk.
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