Development of a Clinical Risk Score for Prediction of Life-Threatening Arrhythmia Events in Patients with ST Elevated Acute Coronary Syndrome after Primary Percutaneous Coronary Intervention

Abstract

ST-elevated acute coronary syndrome (STEACS) is a serious condition requiring timely treatment. Reperfusion with primary percutaneous coronary intervention (pPCI) is recommended and preferred over fibrinolysis. Despite its efficacy, lethal complications, such as life-threatening arrhythmia (LTA), are common in post-PCI patients. Although various risk assessment tools were developed, only a few focus on LTA prediction. This study aimed to develop a risk score to predict LTA events after pPCI. A risk score was developed using a retrospective cohort of consecutive patients with STEACS who underwent pPCI at Chiangrai Prachanukroh Hospital from January 2012 to December 2016. LTA is defined as the occurrence of malignant arrhythmia that requires advanced cardiovascular life support (ACLS) within 72 h after pPCI. Logistic regression was used for model derivation. Among 273 patients, 43 (15.8%) developed LTA events. Seven independent predictors were identified: female sex, hemoglobin <12 gm/dL, pre-and intra- procedural events (i.e., respiratory failure and pulseless arrest), IABP insertion, intervention duration >60 min, and desaturation after pPCI. The LTA score showed an AuROC of 0.93 (95%CI 0.90, 0.97). The score was categorized into three risk categories: low (<2.5), moderate (2.5–4), and high risk (>4) for LTA events. The LTA score demonstrated high predictive performance and potential clinical utility for predicting LTA events after pPCI.

Predictors of in-Hospital Prognosis after Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction Requiring Mechanical Support Devices

“…For AMI sick people confounded with cardiogenic shock, sophisticated heart failure, or malfunctioned reperfusion, mechanical support devices like as percutaneous cardiopulmonary support and intra-aortic balloon pumping are essential in relation to interventional therapy. As a result, AMI sufferers who need mechanical assistance devices are regarded as a category of higher risk acute myocardial infarction sufferers who have a high rate of fatality while hospitalized (Wongthida et al, 2022). Recent studies have shown that repeat acute myocardial infarction people receiving primary PPCI, a diverse group of higher risk AMI patients, had an in-hospital death that was considerably higher compared to that of 1st AMI patients, as well as the factors that determined in-hospital consequences in recurrent AMI sufferers who undergo PPCI were distinctive from those who determined in-hospital consequence in 1st AMI patients (Corpus et al, 2004).…”