Risk is not flat. Comprehensive approach to multidimensional risk management in ST-elevation myocardial infarction treated with primary angioplasty (ANIN STEMI Registry)

Abstract

IntroductionCurrent risk assessment concepts in ST-elevation myocardial infarction (STEMI) are suboptimal for guiding clinical management.AimTo elaborate a composite risk management concept for STEMI, enhancing clinical decision making.Material and methods1995 unselected, registry patients with STEMI treated with primary percutaneous coronary intervention (pPCI) (mean age 60.1 years, 72.1% men) were included in the study. The independent risk markers were grouped by means of factor analysis, and the appropriate hazards were identified.ResultsIn-hospital death was the primary outcome, observed in 95 (4.7%) patients. Independent predictors of mortality included age, leukocytosis, hyperglycemia, tachycardia, low blood pressure, impaired renal function, Killip > 1, anemia, and history of coronary disease. The factor analysis identified two significant clusters of risk markers: 1. age-anemia- impaired renal function, interpreted as the patient-related hazard; and 2. tachycardia-Killip > 1-hyperglycemia-leukocytosis, interpreted as the event-related (hemodynamic) hazard. The hazard levels (from low to high) were defined based on the number of respective risk markers. Patient-related hazard determined outcomes most significantly within the low hemodynamic hazard group.ConclusionsThe dissection of the global risk into the combination of patient- and event-related (hemodynamic) hazards allows comprehensive assessment and management of several, often contradictory sources of risk in STEMI. The cohort of high-risk STEMI patients despite hemodynamically trivial infarction face the most suboptimal outcomes under the current invasive management strategy.

Impact of anaemia on long-term outcomes in patients treated with first- and second-generation drug-eluting stents; Katowice-Zabrze Registry

“…Data from another study showed that PCI with II-DES is associated with lower risk of clinically meaningful restenosis, stent thrombosis, and a lower risk of death compared with I-DES [21]. Considering that the group of patients with anaemia have a higher risk of death [22], recurrent MI [2], and more common complex atherosclerotic lesions, they are at high risk of restenosis after PCI, which makes the use of DES particularly advantageous in them. study there was increase risk of in-hospital bleeding requiring blood transfusion in patients with anaemia.…”

Impact of Selection Criteria on Outcomes of Antithrombotic Trials in Acute Coronary Syndromes

“…The trials with worse bleeding outcomes tended to have more additional inclusion bleeding risk factors than those with neutral or improved bleeding outcomes (2 [1][2][3][4] versus 0 [0-2], respectively, p=0.058). The median number of bleeding risk factors for trials with "net harm" tended to be slightly higher than that for the other studies (2 [0-4] versus 0 [0-2], respectively, p=0.1995).…”

“…We previously introduced a multidimensional risk management concept for ACS [2]. The novel approach differentiates bleeding and hemodynamic hazards allowing conscious management of these contradictory sources of threat.…”

The Relationship Between Gensini Score and In-Hospital Mortality in Patients with ST-Segment Elevation Myocardial Infarction

“…These findings were consistent with previous studies in literature. [20][21][22][23] In the univariate regression analysis, differently from other variables, hemoglobin, hematocrit, albumin and LVEF were found to be negatively correlated to in-hospital mortality, meaning that lower values in these variables were associated to a higher mortality. However, this association was no longer significant after the multivariate analysis, except for LVEF.…”

“…Nevertheless, little is known about the correlation between the Gensini score and short-term mortality in STEMI patients. [20][21][22][23] There are few recently published studies that have evaluated the Gensini score in the context of P-PCI. In a recent report, the Gensini score was found to be associated with lower MACE during hospital stay and at 6 months after PCI in acute STEMI patients.…”