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Early predictors of in-hospital mortality in high-risk ST-elevation myocardial infarction (STEMI) patients

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: Drug Treatment, Other
  • Session type : Poster Session

Authors : A Sinkovic (Maribor,SI), M Marinsek (Maribor,SI), A Markota (Maribor,SI), M Mihevc (Maribor,SI), K Masnik (Maribor,SI), U Kostomaj (Maribor,SI), A Kenk (Maribor,SI), V Kanic (Maribor,SI), F Naji (Maribor,SI)

A Sinkovic1 , M Marinsek1 , A Markota1 , M Mihevc2 , K Masnik2 , U Kostomaj2 , A Kenk2 , V Kanic1 , F Naji1 , 1University Medical Centre Maribor - Maribor - Slovenia , 2University of Maribor, Medical faculty - Maribor - Slovenia ,

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

Background: ST-elevation myocardial infarction (STEMI) population is a heterogenous group of patients with a striking difference in the risk profile, in particular in high-volume centers. High-risk STEMI patients should benefit most from primary percutaneous coronary intervention (PPCI). However, their mortality is increased in spite of PPCI. High-risk in STEMI patients is attributed to older age, comorbidities, pulmonary edema or cadiogenic shock on admission, resuscitation before admission, delays in PPCI, complex coronary anatomy and interventions during PPCI,.
Purpose: To evaluate early predictors of in-hospital mortality of high-risk STEMI patients.
Methods: We retrospectively included 478 high-risk STEMI patients (66,9% men, mean age 63.9 ± 11.8 years), admitted in 2015 and 2016 to the medical ICU. PPCI was performed before or after admission. Age, gender, comorbidities, successful resuscitation before admission, admission pulmonary edema and cardiogenic shock, time to PPCI, the rate of PPCI, the use of P2Y12 receptor inhibitors, mechanical ventilation (MV) and ejection fraction (EF) measurements early after admission were registered and compared between in-hospital nonsurvivors and survivors.
Results: In-hospital mortality of our high-risk STEMI patients was 14% (67 patients). In-hospital nonsurvivors in comparison to survivors were significantly older (68.4±12.8 vs 63.2±11.5, p=0.001) with significantly increased admission Troponin I (34.9±57.7µg/l vs 12.1±26.2µg/l, p < 0.001), blood glucose (14.5±6 mmol/l vs 8.5±3.8 mmol/l, p < 0.001), significantly more likely with anterior STEMI (53.7 vs 46.2%, p=0.012), with presumably new left bundle branch block (LBBB) (19.4% vs 5.1%, p < 0.001), admission pulmonary edema (25.4% v 4.65, p < 0.001) and cardiogenic shock (40.3% vs 4% p < .001), more likely successfully resuscitated before admission (47.8% vs 10.9%, p < 0.001), mechanically ventilated (76.1% vs 11.7%, p < 0.001), but with significantly less likely performed PPCI (52.2% s 77.6%, p=0.001) and with significantly decreased EF (21.5±9.7, p < 0.001) early after admission. Nonsurvivors in comparison to survivors were significantly less likely treated by prasugrel (7.5% vs 25.5%, p=0.003) and significatly more likely by clopidogrel (23.9% vs 95, p < 0.001).
Logistic regression demonstrated that most significnat early independent predictors of in-hospital mortality were older age (OR 1.130, 95%CI 1.047 to 1.221, p=0.002), admission troponin I (OR 1.035, 95%CI 1.006 to 1.065, p=0.019), admission blood glucose (OR 1.43, 95%CI 1.015 to 1.288, p = 0.028), MV (OR OR 0.97, 95% CI 0.017 to 0.559, p=0.009) and EF (OR 0.893, 95%CI 0.824 to 0.968, p=0.006).
Conclusion: In-hospital mortality of high-risk STEMI patients was significantly and independently predicted by older age, increased levels of admission Troponin I and blood glucose, by the need of MV and by systolic dysfunction as evaluated early by EF.

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