Defining high-risk patients with ST-segment elevation acute myocardial infarction undergoing primary percutaneous coronary intervention: A comparison among different scoring systems and clinical definitions

Martinoni, Alessandro; Servi, Stefano De; Politi, Alessandro; Palmerini, Tullio; Musumeci, Giuseppe; Ettori, Federica; Zanini, Roberto; Piccaluga, Emanuela; Sangiorgi, Diego; Repetto, Alessandra; D’Urbano, Maurizio; Castiglioni, Battistina; Fabbiocchi, Franco; Onofri, M; Lauria, Giulia; Cesare, Nicoletta De; Sangiorgi, Giuseppe; Belli, Guido; Poletti, Fabrizio; Pirelli, Salvatore; Klugman, Silvio

doi:10.1016/j.ijcard.2010.12.007

Cited by 5 publications

(7 citation statements)

References 22 publications

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“…with advanced age increases the risk of early adverse outcomes in patients treated by pPCI, which is consistent with literature data [7,8,12]. Studies dealing with risk assessment and adverse events aft er pPCI using scoring systems [13][14][15][16] give age a signifi cant impact as predictor of early adverse outcome, which was confi rmed in a meta-analysis that dealt with the comparison of these studies [16]. On the other hand Teplitsky et al analysis showed that in patients older than 90 years, pPCI was associated with low mortality in clinically stable patients, while clinically unstable patients had much worse prognosis in a six-month followup [17].…”

Section: Discussionsupporting

confidence: 85%

“…Our study showed that the mortality was recorded signifi cantly more in patients with creatinine clearance values less than 60 ccs/min, which represents an independent predictive factor of intrahospital mortality of these patients (Table 3) Our results indicate that hypotension is the factor of adverse prognosis, which may be explained by the higher incidence of heart failure (higher rate according to Killip) and cardiogenic shock in these patients, which represent negative prognostic factors. Th ese results are consistent with other studies [5,13,14,16].…”

supporting

confidence: 93%

“…Acute bundle branch block in patients with AMI is associated with the size of infarction zone, increased frequency of pulmonary edema (Killip III) and cardiogenic shock (Killip IV) [14][15][16]27].…”

mentioning

confidence: 99%

“…Predictors of early mortality obtained in this study represent signifi cant parameters in determining the scores [13][14][15][16] of patients with STEMI treated by pPCI, and are used in order to achieve adequate clinical evaluation of these patients. Adequate risk assessment early aft er pPCI can enable the application of appropriate measures and procedures that would be aimed to reduce or prevent unwanted course and outcome of the illness.…”

mentioning

confidence: 99%

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Clinical and laboratory predictors of early mortality in patients with acute myocardial infarction treated with primary percutaneous coronary intervention

Ruzicic¹,

Ruzicic²,

Mrdovic³

2016

Hosp Pharm Int Multi J

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SUMMARYIntroduction: Primary percutaneous coronary intervention (pPCI) has become the preferred reperfusion strategy in patients with ST-elevation myocardial infarction (STEMI). Previous research studies have shown that certain clinical and laboratory parameters can be associated with early mortality in patients with acute myocardial infarction treated by primary PCI. The Aim: The aim of our study was to determine the clinical and laboratory predictors of an adverse early prognosis of our patients with STEMI treated by primary PCI. Material and Methods:The population of our IV phase, academic, observational, retrospective cross-sectional study comprises a total of 180 consecutive patients, 128 men and 52 women, aged 18, or older, who presented with clinical and electrocardiographic signs of acute STEMI within 12 hours after symptom onset. We analyzed the parameters which were registered in the database system of the Coronary Unit of Emergency Center. Results: The average age of the surviving patients was 58±11, and 67±9 in the deceased patient group but the correlation was not statistically signifi cant (p=0.075). The group of patients who didn't survive had signifi cantly more hypotension on admission (p=0.015), acute bundle branch block on ECG (p=0.032), higher creatinine on admission (p=0.036), patient history of hyperlipidaemia (p=0.044), creatinine clearance below 60ccs/min (p<0.001), Killip>1 heart failure on admission (p=0.038), but this group contained a signifi cantly lower number of smokers (p=0.021). Predictors of an adverse early event in multivariant analysis were: acute bundle branch block, diabetes, Killip> 1 on admission, hypotension on admission, creatinine clearance below 60ccs/min. Conclusions: Our study indicates that acute bundle branch block, diabetes, Killip>1 heart failure on admission, hypotension on admission, creatinine clearence below 60ccs/min, are independent clinical and laboratory predictors of early mortality in patients with STEMI treated by primary PCI.

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Section: Discussionsupporting

confidence: 85%

supporting

confidence: 93%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Clinical and laboratory predictors of early mortality in patients with acute myocardial infarction treated with primary percutaneous coronary intervention

Ruzicic¹,

Ruzicic²,

Mrdovic³

2016

Hosp Pharm Int Multi J

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“…This variation is clinically relevant because, despite the decrease in mortality for myocardial infarction over time, 10 our ability as clinicians to identify patients at high risk of decompensation has not necessarily improved. 36 37 Thus, although inpatient care for STEMI patients may be safer overall, certain populations of patients may continue to be at risk, and efforts to reduce the number of STEMI patients who receive ICU care on average may place these patients at even higher risk in the future.…”

Section: Discussionmentioning

confidence: 99%

Intensive care use and mortality among patients with ST elevation myocardial infarction: retrospective cohort study

Valley

Iwashyna

Cooke

et al. 2019

BMJ

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ObjectiveTo evaluate the effect of intensive care unit (ICU) admission on mortality among patients with ST elevation myocardial infarction (STEMI).DesignRetrospective cohort study.Setting1727 acute care hospitals in the United States.ParticipantsMedicare beneficiaries (aged 65 years or older) admitted with STEMI to either an ICU or a non-ICU unit (general/telemetry ward or intermediate care) between January 2014 and October 2015.Main outcome measure30 day mortality. An instrumental variable analysis was done to account for confounding, using as an instrument the additional distance that a patient with STEMI would need to travel beyond the closest hospital to arrive at a hospital in the top quarter of ICU admission rates for STEMI.ResultsThe analysis included 109 375 patients admitted to hospital with STEMI. Hospitals in the top quarter of ICU admission rates admitted 85% or more of STEMI patients to an ICU. Among patients who received ICU care dependent on their proximity to a hospital in the top quarter of ICU admission rates, ICU admission was associated with lower 30 day mortality than non-ICU admission (absolute decrease 6.1 (95% confidence interval −11.9 to −0.3) percentage points). In a separate analysis among patients with non-STEMI, a group for whom evidence suggests that routine ICU care does not improve outcomes, ICU admission was not associated with differences in mortality (absolute increase 1.3 (−0.9 to 3.4) percentage points).ConclusionsICU care for STEMI is associated with improved mortality among patients who could be treated in an ICU or non-ICU unit. An urgent need exists to identify which patients with STEMI benefit from ICU admission and what about ICU care is beneficial.

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Accuracy of Dedicated Risk Scores in Patients Undergoing Primary Percutaneous Coronary Intervention in Daily Clinical Practice

Abelin

David

Gottschall

et al. 2014

Canadian Journal of Cardiology

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Defining high-risk patients with ST-segment elevation acute myocardial infarction undergoing primary percutaneous coronary intervention: A comparison among different scoring systems and clinical definitions

Cited by 5 publications

References 22 publications

Clinical and laboratory predictors of early mortality in patients with acute myocardial infarction treated with primary percutaneous coronary intervention

Clinical and laboratory predictors of early mortality in patients with acute myocardial infarction treated with primary percutaneous coronary intervention

Intensive care use and mortality among patients with ST elevation myocardial infarction: retrospective cohort study

Accuracy of Dedicated Risk Scores in Patients Undergoing Primary Percutaneous Coronary Intervention in Daily Clinical Practice

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