Effect of selected cardiovascular factors on mortality in patients with ST-segment elevation myocardial infarction
Insights
Patients with ST-segment elevation myocardial infarction (STEMI) who experience cardiogenic shock have significantly higher mortality rates. Key factors influencing survival include age, left ventricular ejection fraction, and cardiac markers, even after percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical cardiovascular event.
- Percutaneous coronary intervention (PCI) is a primary treatment, but outcomes vary.
- Cardiogenic shock complicates STEMI, significantly impacting prognosis.
Purpose of the Study:
- To analyze in-hospital, 30-day, and 1-year mortality rates in STEMI patients treated with PCI.
- To evaluate the impact of cardiovascular factors on mortality in STEMI patients.
- To compare outcomes and influencing factors between shock and non-shock subgroups.
Main Methods:
- Retrospective analysis of 270 STEMI patients treated with PCI.
- Assessment of factors including cardiogenic shock, ischemic time, LVEF, post-PCI TIMI flow, troponin T, CK, and NT-proBNP.
- 12-month follow-up with statistical evaluation of mortality and survival predictors.
Main Results:
- Shock patients exhibited significantly higher in-hospital, 30-day, and 1-year mortality rates compared to non-shock patients (p < 0.001).
- Overall survival was influenced by age, gender, LVEF, NT-proBNP, and post-PCI TIMI flow < 3.
- Survival predictors differed between shock (age, LVEF, TIMI flow) and non-shock (age, LVEF, NT-proBNP, troponin) subgroups.
Conclusions:
- Cardiogenic shock is a major determinant of mortality in STEMI patients undergoing PCI.
- Specific factors like post-PCI TIMI flow, troponin, and NT-proBNP levels are critical in different patient subgroups.
- Despite timely intervention, risk factors significantly affect clinical outcomes and prognosis in STEMI patients.
Objective:
This work was aimed at analyzing in-hospital, 30-day and 1-year mortality rates, impact of selected cardiovascular factors on mortality of patients with ST-segment elevation myocardial infarction (STEMI) manifested on electrocardiogram (ECG) and treated by the percutaneous coronary intervention (PCI) at our cardiac center, comparing the subgroup of non-shock (survivors and deceased) patients after STEMI and evaluating how these patients differ from each other.
Methods:
In total, 270 patients with STEMI manifested on ECG and treated by PCI were enrolled between April 1, 2018, and March 31, 2019, at our cardiologic center. Our study sought to determine the risk of death after acute myocardial infarction with carefully selected factors and parameters such as the presence of cardiogenic shock, ischemic time, left ventricular ejection fraction (LVEF), post‑PCI TIMI (thrombolysis in myocardial infarction) flow and serum levels of cardio‑specific markers, namely troponin T, creatine kinase and N-terminal pro-brain natriuretic peptide (NT-proBNP). Further evaluation included in-hospital, 30-day and 1-year mortality rates in shock and non-shock patients and determination of factors that influence the survival separately in each subgroup. The follow-up was carried out for 12 months after the myocardial infarction in form of outpatient examinations. After 12 months of follow-up, the collected data were statistically evaluated.
Results:
Shock and non-shock patients differed in mortality and several other parameters including NT-proBNP values, ischemic time, TIMI flow defect and LVEF. In all outcomes (in-hospital, 30-day and 1-year mortality rates) the shock patients did worse than non-shock patients (p < 0.001). In addition, age, gender, LVEF, NT-proBNP and post‑PCI TIMI flow less than 3 were found to be important factors influencing the overall survival. In shock patients, the survival was associated with age, LVEF and TIMI flow, while in non-shock patients, the factors predicting survival were age, LVEF, level of NT-proBNP and troponin levels.
Conclusion:
Shock patients differed in terms of mortality in post-PCI TIMI flow, while non-shock patients varied in troponin and NT-proBNP levels. Despite early intervention, certain risk factors might affect the clinical outcome and prognosis of patients with STEMI treated by PCI (Tab. 5, Fig. 1, Ref. 30). Text in PDF www.elis.sk Keywords: myocardial infarction, primary coronary intervention, shock, mortality, cardio‑specific markers.
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