Risk assessment for mortality in patients with ST-elevation myocardial infarction undergoing primary percutaneous
Alireza Oraii1, Melika Shafeghat2,3, Haleh Ashraf4,5
1Students' Scientific Research Center Tehran University of Medical Sciences Tehran Iran.
Insights
Older age and lower mean arterial pressure predict higher mortality in ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI). This highlights the need for vigilant monitoring of high-risk individuals.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Primary percutaneous coronary intervention (PCI) is the standard treatment for ST-elevation myocardial infarction (STEMI).
- Identifying predictors of mortality in STEMI patients undergoing primary PCI is crucial for risk stratification and management.
- This study investigates factors influencing both in-hospital and long-term survival in this patient cohort.
Purpose of the Study:
- To evaluate predictors of in-hospital mortality in STEMI patients undergoing primary PCI.
- To identify independent predictors of long-term mortality in STEMI patients after primary PCI.
- To inform clinical practice regarding the management of STEMI patients.
Main Methods:
- Retrospective analysis of a registry-based cohort of 1123 STEMI patients undergoing primary PCI.
- Multivariate logistic regression was used to determine in-hospital mortality predictors.
- Multivariate Cox regression analysis was employed to identify long-term mortality predictors.
Main Results:
- In-hospital mortality was 5.0%. Independent predictors included older age, lower ejection fraction, lower mean arterial pressure, and higher white blood cell count.
- Long-term mortality follow-up (median 21.8 months) for 875 patients revealed older age, lower mean arterial pressure, and higher blood urea as independent predictors.
- Older age and lower mean arterial pressure were significant predictors for both in-hospital and long-term mortality.
Conclusions:
- Older age and lower mean arterial pressure are key independent predictors of increased mortality risk in STEMI patients treated with primary PCI.
- These findings underscore the importance of intensive monitoring and tailored care for high-risk STEMI patients during and after hospitalization.
- Further research may focus on specific interventions to mitigate mortality risks associated with these identified predictors.
Background And Aims:
Primary percutaneous coronary intervention (PCI) is the treatment of choice in ST-elevation myocardial infarction (STEMI) patients. This study aims to evaluate predictors of in-hospital and long-term mortality among patients with STEMI undergoing primary PCI.
Methods:
In this registry-based study, we retrospectively analyzed patients with STEMI undergoing primary PCI enrolled in the primary angioplasty registry of Sina Hospital. Independent predictors of in-hospital and long-term mortality were determined using multivariate logistic regression and Cox regression analyses, respectively.
Results:
A total of 1123 consecutive patients with STEMI were entered into the study. The mean age was 59.37 ± 12.15 years old, and women constituted 17.1% of the study population. The in-hospital mortality rate was 5.0%. Multivariate analyses revealed that older age (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 1.02-1.10), lower ejection fraction (OR: 0.97, 95% CI: 0.92-0.99), lower mean arterial pressure (OR: 0.95, 95% CI: 0.93-0.98), and higher white blood cells (OR: 1.17, 95% CI: 1.06-1.29) as independent risk predictors for in-hospital mortality. Also, 875 patients were followed for a median time of 21.8 months. Multivariate Cox regression demonstrated older age (hazard ratio [HR] = 1.04, 95% CI: 1.02-1.06), lower mean arterial pressure (HR = 0.98, 95% CI: 0.97-1.00), and higher blood urea (HR = 1.01, 95% CI: 1.00-1.02) as independent predictors of long-term mortality.
Conclusion:
We found that older age and lower mean arterial pressure were significantly associated with the increased risk of in-hospital and long-term mortality in STEMI patients undergoing primary PCI. Our results indicate a necessity for more precise care and monitoring during hospitalization for such high-risk patients.
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