Non-reperfused ST-elevation myocardial infarction: notions from a low-to-middle-income country
Rodrigo Gopar-Nieto1, Héctor González-Pacheco1, Alexandra Arias-Mendoza1
1Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
Insights
Mortality is higher in patients with non-reperfused ST-segment elevation myocardial infarction (STEMI). Predictors of in-hospital death include renal dysfunction, low blood pressure, and reduced left ventricle ejection fraction.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical cardiovascular event.
- Timely reperfusion therapy is crucial for improving outcomes in STEMI patients.
- Understanding mortality predictors in non-reperfused STEMI is essential for risk stratification.
Purpose of the Study:
- To compare characteristics and outcomes of survivors versus non-survivors with non-reperfused STEMI.
- To identify key predictors of in-hospital mortality in this patient cohort.
Main Methods:
- Retrospective cohort study of 2442 non-reperfused STEMI patients (October 2005 - August 2020).
- Classification into survivor and non-survivor groups.
- Comparison of patient demographics, comorbidities, treatments, and in-hospital outcomes.
Main Results:
- In-hospital mortality was 12.7% in non-reperfused STEMI versus 7.2% in reperfused STEMI.
- Delayed presentation was the primary reason for non-reperfusion (96.1%).
- Non-survivors were older, more frequently female, and had higher rates of diabetes, hypertension, atrial fibrillation, left main coronary disease, and three-vessel disease.
- Non-survivors experienced higher rates of heart failure, reinfarction, atrioventricular block, bleeding, stroke, and death.
- Key mortality predictors: renal dysfunction (HR 3.41), systolic blood pressure < 100 mmHg (HR 2.26), and left ventricle ejection fraction < 40% (HR 1.97).
Conclusions:
- Non-reperfused STEMI is associated with significantly higher mortality and adverse in-hospital outcomes compared to reperfused STEMI.
- Older age, increased comorbidities, and specific clinical factors predict higher mortality in non-reperfused STEMI.
- Identifying these predictors allows for targeted interventions and improved management strategies for high-risk STEMI patients.
Objective:
The objective of the study was to analyze the differences between survivors and non-survivors with non-reperfused ST-segment elevation myocardial infarction (STEMI) and to identify the predictors of in-hospital mortality.
Methods:
A retrospective cohort study included non-reperfused STEMI patients from October 2005 to August 2020. Patients were classified into survivors and non-survivors. We compared patient characteristics, treatments, and outcomes among the groups and identified factors associated with in-hospital mortality.
Results:
We included 2442 patients with non-reperfused STEMI and we found a mortality of 12.7% versus 7.2% in reperfused STEMI. The main reason for non-reperfusion was delayed presentation (96.1%). Non-survivors were older, more often women, and had diabetes, hypertension, or atrial fibrillation. The left main coronary disease was more frequent in non-survivors as well as three-vessel disease. Non-survivors developed more in-hospital heart failure, reinfarction, atrioventricular block, bleeding, stroke, and death. The main predictors for in-hospital mortality were renal dysfunction (HR 3.41), systolic blood pressure < 100 mmHg (HR 2.26), and left ventricle ejection fraction < 40% (HR 1.97).
Conclusion:
Mortality and adverse outcomes occur more frequently in non-reperfused STEMI. Non-survivors tend to be older, with more comorbidities, and have more adverse in-hospital outcomes.
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