Clinical Characteristics and Outcomes of Patients Presenting With Acute Myocardial Infarction Without Cardiogenic
Hiroshi Okamoto1, Takeshi Nishi1, Masanobu Ishii2
1Department of Cardiology, Kawasaki Medical School.
Insights
Patients with acute myocardial infarction (AMI) who are not in cardiogenic shock (AMI-NCS) are older with more comorbidities, leading to increased complications. Primary percutaneous coronary intervention (PPCI) improves outcomes for these patients.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Most acute myocardial infarction (AMI) patients present hemodynamically stable (non-cardiogenic shock, AMI-NCS).
- Limited research exists on the specific clinical profiles and outcomes of AMI-NCS patients.
- This study examines trends in AMI-NCS patient characteristics, adverse events, and the impact of primary percutaneous coronary intervention (PPCI).
Purpose of the Study:
- To analyze temporal trends in clinical characteristics of AMI-NCS patients.
- To investigate in-hospital adverse outcomes in AMI-NCS patients.
- To evaluate the effect of PPCI on outcomes for AMI-NCS patients.
Main Methods:
- Utilized a nationwide Japanese administrative database from April 2012 to March 2018.
- Included 176,275 AMI-NCS patients, representing 67.7% of the total AMI population.
- Performed multivariable analyses to identify factors associated with mortality and complications.
Main Results:
- AMI-NCS patients are aging, with increasing comorbidity burden over the study period.
- 30-day mortality remained stable (2.6%), but in-hospital complications rose significantly (30.5%), particularly major non-cardiac events.
- Older age, higher Killip class, atrial fibrillation, chronic renal failure, and malignancy were linked to worse outcomes, while PPCI was associated with better outcomes.
Conclusions:
- The clinical profile of AMI-NCS patients is becoming more complex, with rising age and comorbidities.
- Increased in-hospital complications necessitate proactive management strategies.
- Wider adoption of PPCI could reduce adverse events and enhance survival in AMI-NCS patients.
Background:
Most patients with acute myocardial infarction (AMI) present in the emergency department in a hemodynamically stable condition (i.e., non-cardiogenic shock) (AMI-NCS). However, few studies specifically focused on the clinical characteristics and outcomes of AMI-NCS patients. Temporal trends in clinical characteristics, in-hospital occurrence of in-hospital adverse outcomes, and the effect of primary percutaneous coronary intervention (PPCI) were examined.
Methods And Results:
Between April 2012 and March 2018, 176,275 AMI-NCS patients (67.7% of the total AMI population; 25.4% female; mean age 68.6±13.1 years) were identified in a nationwide Japanese administrative database. During the 6-year study period, AMI-NCS patients have been getting older and had an increasing burden of comorbidities. The rates of 30-day all-cause mortality and in-hospital complications were 2.6% and 30.5%, respectively. Thirty-day all-cause mortality did not change significantly over time, whereas in-hospital complications, especially major non-cardiac events, increased progressively. On multivariable analyses, higher age, higher Killip class, atrial fibrillation, chronic renal failure, and malignancy were independently associated with both increased 30-day mortality and in-hospital complications. PPCI was independently associated with lower mortality and in-hospital complications.
Conclusions:
The clinical background of AMI-NCS patients has been becoming more complex with increasing age and the burden of comorbidities, with increased in-hospital complications. More active and appropriate application of PPCI may further decrease adverse events and improve survival of AMI-NCS patients.
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