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In-hospital complications and mortality in ST-elevation myocardial infarction (STEMI) patients declined from 2008 to 2014

Session Poster Session 3 - ST Elevation Acute Coronary Sydrome

Speaker Andreja Sinkovic

Event : Acute Cardiovascular Care 2018

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
  • Session type : Poster Session

Authors : A Sinkovic (Maribor,SI), M Marinsek (Maribor,SI), F Naji (Maribor,SI), V Kanic (Maribor,SI), A Markota (Maribor,SI)

Authors:
A Sinkovic1 , M Marinsek1 , F Naji1 , V Kanic1 , A Markota1 , 1University Medical Centre Maribor - Maribor - Slovenia ,

Citation:
European Heart Journal Supplement ( 2018 ) 7 ( Supplement ), S219

Background: Primary percutaneous coronary intervention (PPCI) is the leading reperfusion strategy in our institution for more than a decade in patients with ST-elevation myocardial infarction on ECG (STEMI). Novel antithrombotic drugs within the last few years promised to improve prognosis of STEMI patients after PPCI even further.
Purpose: To compare clinical outcomes between STEMI patients, admitted in 2008 and 2014.
Methods: We retrospectively included 291 STEMI patients, admitted in 2008 and 274 STEMI patients, admitted in 2014. We compared their clinical data, the use of PPCI and novel antithrombotic drugs, in-hospital complications and in-hospital, 30-day and 6-month mortality. In-hospital complications were acute heart failure (classes II-IV by Killip-Kimbal classification), arrhythmias, bleedings, reinfarctions, in-stent thromboses and acute kidney injury.
Results: Between STEMI patients, admitted in 2008 and 2014, we observed nonsignificant differences in mean age (63.9±13.4 years vs 64.6±12.8 years), in the incidence of smoking (31.9% vs 28.1%) and of prior diabetes (21.6% vs 19.7%), but significantly increased incidence of arterial hypertension (49.6% vs 58.8%, p < 0.05) and of prior myocardial infarction (1.4% vs 12.4%, p < 0.05). The use of PPCI increased only nonsignificantly from 2008 to 2014 (90% vs 90.9%), but the use of PPCI increased significantly within the first 3 hours of STEMI (23.4% vs 33.6%, p = 0.01), but nonsignificantly within the first 6 hours (50.8% vs 54%) and 12 hours (63.9% vs 66%) of chest pain.
From 2008 to 2014 the insertion of stents increased significantly (76.9% vs 84.3%, p < 0.05), the use of clopidogrel significantly decreased (91.4% vs 12.8%, p < 0.05), but the use of prasugrel (0.7% vs 29.9%, p < 0.001) and of ticagrelor (0 vs 51.5%, p < 0.001) significantly increased. From 2008 to 2014 the use of heparins (89% vs 75.2%, p < 0.001) and glycoprotein receptor inhibitors IIb/IIIa (90% vs 33.6%, p < 0.001) decreased significantly, the use of bivalirudin significantly increased (0% vs 22.3%, p < 0.001).
From 2008 to 2014 we observed a significant decrease of in-hospital heart failure (32.6% vs 18.9%, p < 0.05), bleedings (10.9% vs 4.3%, p < 0.001), acute kidney injury (9,6% vs 4,4%, p = 0,025), a nonsignificant decrease in infection (21.3% vs 17.5%), reinfarctions (2.4% vs 0.3%, p > 0.05) and in-stent thombosis (2% vs 0.6%, p > 0.05) and nonsignificant increase of arrhythmias (34% vs 38.3) in STEMI patients. Mortality data decreased nonsignificantly – in-hospital mortality from 9.6% to 6.6%, 30-day mortality from 11.7% to 9.1% and 6-month mortality from 15.1% to 9.5%.
Conclusions: From 2008 to 2014 we observed a significant increase in the use of novel antithrombotic drugs in STEMI patients, treated by PPCI and in paralell a significant decrease of in-hospital complications such as acute heart failure, bleedings and acute kidney injury, but nonsignificant decrease in mortality data.

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