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Predictors of in-hospital mortality in patients with acute coronary syndrome in Kosovo

Session Poster Session 3

Speaker Zarife Rexhaj

Event : Heart Failure 2019

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease: Treatment, Revascularization
  • Session type : Poster Session

Authors : G Bajraktari (Pristina,XK), E Haliti (Pristina,XK), A Ahmeti (Pristina,XK), A Batalli (Pristina,XK), A Poniku (Pristina,XK), E Koci (Pristina,XK), A Ferati (Pristina,XK), R Leka (Pristina,XK), E Zhubi (Pristina,XK), Z Rexhaj (Pristina,XK), F Zhubi-Bakija (Pristina,XK), A Leka (Pristina,XK), F Shatri (Pristina,XK), H Selmani (Pristina,XK), S Elezi (Pristina,XK)

Authors:
G Bajraktari1 , E Haliti1 , A Ahmeti1 , A Batalli1 , A Poniku1 , E Koci1 , A Ferati1 , R Leka1 , E Zhubi1 , Z Rexhaj1 , F Zhubi-Bakija1 , A Leka1 , F Shatri1 , H Selmani1 , S Elezi1 , 1University Clinical Centre of Kosova (UCC), Service of Cardiology - Pristina - Kosovo Republic of ,

Citation:

Background and Aim: Acute coronary syndrome (ACS) is the major cause of mortality and hospital admissions. The management and outcome of patients with ACS vary in different countries and regions. The in-hospital mortality of these patients declined significantly in developed and developing countries after the introducing of primary percutaneous intervention (PPCI). There are no data regarding mortality and hospital admission of patients with ASC in Kosovo. The objective of this study was to assess possible predictors of in-hospital mortality in patients admitted with ACS.

Methods: This retrospective study included all patients hospitalized for ACS from January 1st, 2014 to December 31st, 2018, at the Clinic of Cardiology of our University Clinical Center in Kosovo. According to the presenting electrocardiogram, acute myocardial infarction (MI) was categorized as non-ST-segment elevation MI (NSTEMI) and ST-segment elevation MI (STEMI). The in-hospital mortality was defined as the death from the time of the admission till the patient’s discharge.

Results: Among 4667 admitted patients with ACS (mean age 63 ± 12 years, 30% female), according to the final discharged diagnosis, 2982 (64%) patients were identified with STEMI,  1685 (36%) with NSTEMI or unstable angina. Of all ACS patients, 49% underwent diagnostic coronary angiography, 34 0% underwent PPCI, 13 % were referred for coronary artery by-pass graft surgery, and 24 % were transferred to a 24 hours PPCI center. The rest of patients were treated medically. In-hospital mortality in the whole group of patients was 8.4%, whereas in patients that were not transferred to the 24 hours PCI center for PPCI it was 8.9%. The mortality rate was higher in patients that did not underwent reperfusion by PPCI compared to those that underwent (10.6% vs. 4.1%, p<0.001), and even higher in patients that didn’t underwent diagnostic coronary arteriography (12.2%). Diabetic patients had higher mortality rate compared to non-diabetic patients (p<0.001), female patients had higher mortality rate compared to male patients (p<0.001) and non-smokers had higher mortality rate compared to smokers (p<0.001). Older age [1.046 (1.025-1.067), p<0.001], low left ventricular ejection fraction [0.962 (0.946-0.978), p<0.001], the presence of STEMI [2.051 (1.295-3.248), p=0.002], high level of creatinine [1.004 (1.002-1.006), p<0.001] and the luck of PPCI intervention [0.338 (0.202-0.566), p<0.001] were independent predictors of in-hospital mortality in ACS patients, in the multivariate analysis. Conclusion: During last five years, the majority of patients with ACS were not treated with PPCI in Kosovo, in whom the in-hospital mortality rate was high. The luck of PPCI intervention, older age, compromised global left ventricular systolic function and renal function are the main predictors of in-hospital mortality in patients with ACS.

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