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Predictors of in-Hospital Mortality of ST-Segment Elevation Myocardial Infarction Patients Undergoing Interventional Treatment. An Analysis of Data from the RO-STEMI Registry
Background: ST-segment elevation myocardial infarction (STEMI) remains a leading cause of morbidity and mortality worldwide. Primary percutaneous coronary intervention (pPCI) is the preferred therapy for STEMI if it is done within 120 min from the first medical contact, by an experienced team in a high-volume center. The aim of this study was to assess the clinical characteristics and predictors of in-hospital mortality of patients with STEMI treated by percutaneous coronary interventions (PCIs).
Methods: We analyzed data from 15,076 STEMI patients enrolled in the RO-STEMI registry (ROmanian ST-Elevation Myocardial Infarction registry). Patients were divided into 2 groups: PCI (11.669; 77%) and conservative treated (3.407; 23%). PCI group includes both pPCI treated patients (84.3%), and patients undergoing rescue PCI (6.4%) and late PCI (9.3%).
Results: The mean age of STEMI patients was 62.7+/-12.7 years. 70% were males. Patients treated by PCI were younger (61.4+/-12.2 versus 67.2+/-13.3, p<0.0001) and more often men (80% versus 71%, p<0.0001). They were less likely to have acute heart failure (Killip class II-IV) at admission (p<0.0001). During admission, patients treated by PCI received more often dual antiplatelet therapy (97.6% versus 90.8%, p<0.0001), statins (96.3% versus 87.5%, p<0.0001), beta-blockers (83.8% versus 73.2%, p<0.0001), and RAAS blockers (82.6% versus 66.4%, p<0.0001). Overall in-hospital mortality was 7.1%: 4.1% in the PCI group and 15.7% in the conservative treated group. Multivariate analysis showed that, after adjusting for all clinical variables, Killip class II-IV at admission (OR: 9.2; 95%CI: 6.2-13.6; p<0.0001), LVEF<35% (OR: 3.8; 95%CI: 2.6-5.4; p<0.0001), age older than 65 years (OR: 2.2; 95%CI: 1.5-3.2; p<0.0001), and anterior location of myocardial infarction (OR: 2.1; 95% CI: 1.5-3; p<0.0001) remained independent predictors for in-hospital mortality for STEMI patients treated interventionally.
Conclusion: Advanced Killip class, depressed LVEF, advanced age, and anterior location were the most powerful independent predictors of in-hospital mortality in STEMI patients who underwent interventional treatment.
Keywords: STEMI, percutaneous coronary interventions, mortality