Predictors of in-hospital mortality in patients with ST-segment elevation myocardial infarction undergoing pharmacoinvasive treatment

Abstract

OBJECTIVES:To identify predictors of in-hospital mortality in patients with acute myocardial infarction undergoing pharmacoinvasive treatment.METHODS:This was an observational, prospective study that included 398 patients admitted to a tertiary center for percutaneous coronary intervention within 3 to 24 hours after thrombolysis with tenecteplase. ClinicalTrials.gov: NCT01791764RESULTS:The overall in-hospital mortality rate was 5.8%. Compared with patients who survived, patients who died were more likely to be older, have higher rates of diabetes and chronic renal failure, have a lower left ventricular ejection fraction, and demonstrate more evidence of heart failure (Killip class III or IV). Patients who died had significantly lower rates of successful thrombolysis (39% vs. 68%; p = 0.005) and final myocardial blush grade 3 (13.0% vs. 61.9%; p<0.0001). Based on the multivariate analysis, the Global Registry of Acute Coronary Events score (odds ratio 1.05, 95% confidence interval (CI) 1.02-1.09; p = 0.001), left ventricular ejection fraction (odds ratio 0.9, 95% CI 0.89-0.97; p = 0.001), and final myocardial blush grade of 0-2 (odds ratio 8.85, 95% CI 1.34-58.57; p = 0.02) were independent predictors of mortality.CONCLUSIONS:In this prospective study that evaluated patients with ST-segment elevation myocardial infarction treated by a pharmacoinvasive strategy, the in-hospital mortality rate was 5.8%. The Global Registry of Acute Coronary Events score, left ventricular ejection fraction, and myocardial blush were independent predictors of mortality in this high-risk group of acute coronary syndrome patients.

Effects of four antiplatelet/statin combined strategies on immune and inflammatory responses in patients with acute myocardial infarction undergoing pharmacoinvasive strategy: Design and rationale of the B and T Types of Lymphocytes Evaluation in Acute Myocardial Infarction (BATTLE-AMI) study: study protocol for a randomized controlled trial

“…The BATTLE-AMI study (NCT02428374) will include approximately 300 men and women aged > 18 years with documented STEMI submitted to fibrinolytic therapy (tenecteplase, TNK) in the first 6 h of onset of symptoms in public hospitals of São Paulo, Brazil, as part of the SP STEMI treatment network (NCT01791764) [ 24 ]. In the network routine, patients are subsequently transferred to a tertiary teaching hospital and undergo systematic early invasive coronary angiography (<24 h, designated as pharmacoinvasive strategy).…”

The derivation and validation of a simple model for predicting in-hospital mortality of acutely admitted patients to internal medicine wards

“…[ 2 , 3 ] Numerous studies have consistently shown that comorbidity is one of the main factors associated with adverse outcomes among hospitalized patients. [ 4 , 5 ] To date, nearly all prediction model studies that investigated the association between various variables and in-hospital mortality focused on specific patient populations such as patients with pneumonia, [ 6 ] congestive heart failure (CHF), [ 7 ] acute myocardial infarction, [ 8 ] chronic obstructive pulmonary disease (COPD), [ 9 ] stroke, [ 10 ] infective endocarditis, [ 11 ] and cancer. [ 12 ] In addition, these studies mainly addressed associations between the main diagnosis at hospital discharge notes and various variables, without adjustment for secondary diagnoses or concomitant conditions that coexisted at the time of admission or that developed during hospital stay.…”

Epidemiological Profile and Quality Indicators in Patients with Acute Coronary Syndrome in Northern Minas Gerais - Minas Telecardio 2 Project

“…The Brazilian Ministry of Health has established a priority for the MI system of care, 7 but the national experience in this area is still lacking. 8 - 12 The Northern Region of Minas Gerais (MG) is a geographical area with adverse and peculiar conditions, such as low socioeconomic level, large territorial extension (which covers 89 municipalities), and logistical challenges that affect patient care, including unpaved roads, routes that require transportation by ferry boats, and ambulance interception 13 , 14 ( Figure 1 ). The implementation of an MI system of care in such conditions is particularly challenging.…”