Factors Associated with In-hospital Mortality in Patients with Acute Coronary Syndrome

Abstract

Introduction: The recent development of large networks dedicated to ST-segment elevation myocardial infarction (STEMI) led to a significant increase in the number of primary percutaneous interventions (p-PCI) parallel with mortality reduction in Acute Coronary Syndrome (ACS). The number of non ST segment elevation myocardial infarction (NSTEMI) is increasing and the highest mortality rates are encountered in patients with cardiogenic shock and/or out of hospital cardiac arrest associated to ACS. The aim of this study was to identify the factors associated with a higher mortality rate in a global population with acute coronary syndromes presented in the emergency department of a county clinical hospital which serves as a regional center for a STEMI network. Material and method: This is a retrospective study including 684 patients with acute coronary syndrome admitted in the Clinic of Cardiology from the County Clinical Emergency Hospital Tîrgu Mureș in 2014. In all the cases, the factors that correlated with in hospital mortality were identified and analyzed. Results: The incidence of arterial hypertension was significantly higher in patients admitted with unstable angina (75.0%) and STEMI cases with less than 12 hours onset of symptomatology (68.1%), while impaired renal function correlated with the presence of NSTEMI (66.6%). The presence of a multivessel disease was significantly correlated with cardiogenic shock. The localisation of the culprit lesion in the left anterior descending artery (LAD) significantly correlated with the development of cardiogenic shock, LAD culprit lesions being present in 44.4% of CS cases as compared with 21.7% of noCS cases in STEMI patients. In NSTEMI patients, the localisation of the culprit lesion in the left main artery (LM) significantly correlated with the development of cardiogenic shock, culprit lesions in the left main being present in 47.0% of CS cases as compared with 28.5% of noCS cases in STEMI patients. Conclusion: Patients presenting with out-of-hospital resuscitated cardiac arrest due to Acute Myocardial Infarction associate higher in-hospital mortality rates. In-hospital mortality seems to be highly correlated with the female gender, STEMI myocardial infarction and the presence of multivascular lesions.

Response to Fragmented QRS Complex Predicts Contrast‐Induced Nephropathy and In‐Hospital Mortality After Primary Percutaneous Coronary Intervention in Patients With ST‐Segment Elevation Myocardial Infarction

“…However, increased time from chest pain to revascularization has been proven to represent 1 of the most significant predictors of STEMI-related mortality, 2,3 and STEMI networks for fast reperfusion have been implemented worldwide, demonstrating that a significant reduction in STEMI mortality is achievable via reducing the time from symptoms onset to PCI. 4,5 The fact that the presence of fQRS in this study was associated with a higher mortality, but at the same time did not correlate with one of the most significant predictors of mortality validated so far in the STEMI population (the time from symptoms onset to reperfusion), is a surprising finding. It would be interesting to analyze and discuss this further.…”

New Developments in the Treatment of Acute Myocardial Infarction Associated with Out-of-Hospital Cardiac Arrest. A Review

“…[22][23][24][25] In patients without ST-segment elevation, as recorded on the post-ROSC electrocardiogram, the decision to perform early PCI can depend on numerous factors. 26 As the specificity and sensitivity of clinical data and biomarkers are less accurate after OHCA, a decision may be extremely difficult to arrive at in such cases. Hemodynamic status, age, duration of CPR or neurological status can all influence the decision of undertaking or postponing coronary angiography.…”

Mortality Reduction in Acute Coronary Syndromes — How Far Are We From The Goal?

“…At the same time, heart failure is a strong predictor of acute kidney failure in patients with STEMI undergoing primary PCI [4]. Other studies demonstrated the impact of multivessel disease on the outcome of the revascularization procedure, being generally accepted that the presence of a multivessel disease has a negative impact on the survival of ACS patients [5].…”