Clinical outcomes of patients undergoing primary percutaneous coronary intervention for acute myocardial infarction requiring the intensive care unit

Abstract

BackgroundOutcomes for patients with ST-segment elevation myocardial infarction continue to improve, largely due to timely provision of reperfusion by primary percutaneous coronary intervention (PPCI). However, despite prompt and successful PPCI, a small proportion of patients require ventilatory and hemodynamic support in an intensive care unit (ICU). The outcome of these patients remains poorly defined.MethodsA retrospective review of all consecutive admissions post-PPCI pathway to a single ICU between January 2009 and May 2014 was performed. Patients were analysed based on survival and indication for admission. Preadmission characteristics and ICU course were reviewed. Univariate and multivariable regression analysis was performed to determine predictors of outcome.ResultsDuring the study period 2902 PPCI were performed and 101 patients were admitted to ICU following PPCI (incidence 3.5%). ICU mortality post-PPCI was 33.7%. Pre-ICU admission factors in a multivariable logistic regression analysis associated with increased mortality included requirement for an intra-aortic balloon pump and a high SOFA score.ConclusionsICU admission post PPCI is associated with significant mortality. Mortality was related to high presenting SOFA score and need for IABP. These results provide important prognostic information and an acceptable method for risk-stratifying patients with acute myocardial infarction requiring intensive care.Electronic supplementary materialThe online version of this article (10.1186/s40560-018-0275-y) contains supplementary material, which is available to authorized users.

Intensive care use and mortality among patients with ST elevation myocardial infarction: retrospective cohort study

“… 45 46 47 Secondly, most previous studies suggested increased mortality among patients admitted to an ICU, but these studies are at risk for confounding by indication and for estimating average rather than the more clinically relevant marginal treatment effects (that is, the effect on patients who could reasonably be treated in either ICU or non-ICU settings). 48 49 50 Our unadjusted and adjusted results also showed increased mortality associated with ICU admission. Other instrumental variable analyses have similarly shown a shift in the effect compared with conventional regression analyses.…”

Correction to: Clinical outcomes of patients undergoing primary percutaneous coronary intervention for acute myocardial infarction requiring the intensive care unit

“…In the original publication of this article [ 1 ], one author’s name was misspelling. Catherine Jaworksi should be Catherine Jaworski.…”

In-Hospital Mortality With No-Reflow During Primary Percutaneous Coronary Intervention

“…While PPCI has substantially improved the outcomes of AMI patients, the occurrence of the "no-reflow" phenomenon during the procedure remains a perplexing challenge in the field of interventional cardiology (Sunamura et al, 2017). AMI, commonly referred to as a heart attack, is a medical emergency characterized by the sudden cessation of blood flow to a portion of the heart muscle, leading to ischemia and potential myocardial damage (Dubey et al, 2017;Parhar et al, 2018). This procedure aims to salvage viable myocardium, reduce infarct size, and improve the patient's overall prognosis.…”