In-hospital mortality among consecutive patients with ST-Elevation myocardial infarction in modern primary percutaneous intervention era ~ Insights from 15-year data of single-center hospital-based registry ~

Abstract

Objective To clarify the association of detailed angiographic findings with in-hospital outcome after primary percutaneous coronary intervention (p-PCI) for ST-elevation myocardial infarction (STEMI) in Japan. Background Data regarding the association of detailed angiographic findings with in-hospital outcome after STEMI are limited in the p-PCI era. Methods Between January-2004 and December-2018, 1735 patients with STEMI (mean age, 68.5 years; female, 24.6%) who presented to the hospital in the 24-hours after symptom onset and underwent p-PCI were evaluated using the disease registries. The registry is an ongoing, retrospective, single-center hospital-based registry. Results The 30-day mortality rate and in-hospital mortality rate were 7.7% and 9.2%, respectively. Independent predictors of in-hospital mortality were ejection fraction (EF) < 40% [adjusted Odds Ratio (aOR), 4.446, p < 0.001], culprit lesions in the left coronary artery (LCA) (aOR, 2.940, p < 0.001) compared with those in the right coronary artery, Killip class > II (aOR, 7.438; p < 0.001), chronic kidney disease (CKD) (aOR, 4.056; p < 0.001), final thrombolysis in myocardial infarction (TIMI) grades 0/1/2 (aOR, 1.809; p = 0.03), absence of robust collaterals (aOR, 17.309; p = 0.01) and hypertension (aOR, 0.449; p = 0.01). Conclusions Among the consecutive patients with STEMI, the in-hospital mortality rate after p-PCI significantly improved in the second half. Not only CKD, Killip class > II, and EF < 40%, but also the angiographic findings such as culprit lesions in the LCA, absence of very robust collaterals, and final TIMI grades <3 were associated with an increased risk of in-hospital mortality.

Treatment Outcomes of Acute Coronary Syndrome Patients in Bangkok Dusit Medical Services (TOACS-BDMS)

“…For ACS patients, in-hospital mortality rate in cardiogenic shock in this registry was higher than those without CS comparable to other ACS registries. hospital mortality rate was lower than the Culprit shock trial (60.00%) 20 and close to recent study from PCI Center ACS registry in Korea (11.00%) 21 , and Japan (9.20%) 22 .…”

North American COVID-19 Myocardial Infarction (NACMI) Risk Score for Prediction of In-Hospital Mortality

“…In-hospital mortality in the pre-COVID-19 STEMI registries ranges from 2% to 10%. 10 , 12 , 13 , 14 , 15 In a recent contemporary analysis from the United States, the in-hospital mortality of uncomplicated STEMI was 2% but increased substantially in patients with cardiogenic shock (23%), cardiac arrest (19%), or both (44%). 15 Although viral illnesses are known to increase the incidence of myocardial infarction and death, 16 , 17 , 18 the 28% in-hospital mortality observed in patients with COVID-19 and STEMI in the NACMI registry was higher than a contemporary cohort of patients without COVID-19 (mortality rate of 11%) from the same sites and a propensity-matched prepandemic cohort for a large regional STEMI registry (mortality rate of 4%).…”

Pre-infarction Angina: Time Interval to Onset of Myocardial Infarction and Comorbidity Predictors

“…The in-hospital mortality rate of patients with acute myocardial infarction (MI) has improved to <10% due to advanced treatment after hospital admission, including primary percutaneous coronary intervention (1)(2)(3). Nevertheless, many cardiac arrests and deaths occur out-of-hospital, and acute MI remains a life-threatening condition worldwide (4).…”