Determinants of In-Hospital Death in Acute Myocardial Infarction With Triple Vessel Disease

Abstract

SummaryCompared to acute myocardial infarction (AMI) with single vessel disease (SVD) or double vessel disease (DVD), AMI with triple vessel disease (TVD) is associated with higher mortality. The aim of this study was to identify the determinants of in-hospital death in AMI with TVD. We identified AMI patients with TVD in our tertiary medical center between January 2009 and December 2014. Baseline patient characteristics including laboratory data, echocardiograms, and coronary angiograms were collected from our hospital records. We divided our study population into a survivor group and non-survivor group. Multivariate stepwise logistic regression analysis was performed to identify the determinants of in-hospital death. A total of 138 AMI patients with TVD were identified and included as the final study population. Fifteen patients died during the hospitalization (mortality rate, 10.9%). Mean systolic blood pressure (134 ± 27 mmHg) was significantly greater in the survivor group compared with the non-survivor group (114 ± 31 mmHg) (P = 0.02). The prevalence of shock on admission was significantly less in the survivor group (15.4%) than in the non-survivor group (66.7%) (P < 0.001). Multivariate stepwise logistic regression analysis revealed that shock status on admission (OR 11.50, 95% CI 3.21-41.14, P < 0.001), the left anterior descending artery (LAD) as the infarct related artery (IRA) (OR 3.83, 95% CI 1.04-14.09, P = 0.04), and serum albumin on admission (OR 0.26, 95% CI 0.08-0.84, P = 0.02) were significantly associated with in-hospital death. In conclusion, shock status on admission, the LAD as the IRA, and a low serum albumin level were the determinants of in-hospital death in AMI patients with TVD. ( 1,2) The in-hospital mortality rates of AMI complicated with cardiogenic shock with SVD, DVD, and TVD were reported to be 32.8%, 45.1%, and 58.2%, respectively. 1) Furthermore, the long-term mortality of AMI with TVD is poorer than that with DVD.2) Although several groups studied the determinants of poor clinical outcomes in AMI with multivessel disease, 3,4) the determinants of in-hospital death in AMI with TVD have not been fully investigated. It is clinically important to identify such determinants in order to obtain a better understanding of AMI with TVD, because the mortality of AMI with TVD is the greatest among AMI.

Risk Scoring System for Prognosis Estimation of Multivessel Disease Among Patients with ST-Segment Elevation Myocardial Infarction

“…4) Van der Schaaf, et al and the authors of this manuscript independently showed that multivessel disease (MVD) was significantly related with higher mortality compared to single vessel disease (SVD) in STEMI patients. [8][9][10][11] Therefore, we surmised that a practical and meaningful RSS for MVD with STEMI should be introduced in clinical practice to reduce major adverse cardiac events (MACEs) in this high-risk population. Even though considerable numbers of RSSs for ACS patients have been developed and are in use, little is known regarding the risk score of MVD with STEMI.…”

The Comparison of Clinical Outcomes Between Inferior ST-Elevation Myocardial Infarction with Right Ventricular Infarction Versus Without Right Ventricular Infarction

“…The diagnosis of AMI required the following criteria: symptoms consistent with AMI; elevated cardiac enzymes including troponin T, troponin I, and/or creatinine kinase (at least two-fold increase from the normal upper limit); and ST-segment elevation or depression in electrocardiograms compatible with AMI. 6) RVI criteria were defined as ST-segment elevation in V4R (!1 mm) or abnormal right ventricular wall motion in the echocardiogram, accompanying clinical symptoms such as hypotension. 7) We included only inferior STEMI whose infarct related artery (IRA) was the right coronary artery (RCA).…”

“…Definition: Hypertension was defined as medical treatment for hypertension and/or a history of hypertension before admission. 6) Dyslipidemia was defined as a total cholesterol level of !220 mg/dL or low-density lipoprotein cholesterol level of !140 mg/dL or medical treatment for dyslipidemia or a history of dyslipidemia. 6,8) Diabetes mellitus was defined as a hemoglobin A1c level of !6.5% (as NGSP value) or medical treatment for diabetes mellitus or a history of diabetes mellitus.…”

“…6) Dyslipidemia was defined as a total cholesterol level of !220 mg/dL or low-density lipoprotein cholesterol level of !140 mg/dL or medical treatment for dyslipidemia or a history of dyslipidemia. 6,8) Diabetes mellitus was defined as a hemoglobin A1c level of !6.5% (as NGSP value) or medical treatment for diabetes mellitus or a history of diabetes mellitus. 6) We also calculated the estimated glomerular filtration rate (eGFR) from the serum creatinine level, age, weight, and gender using the following formula: eGFR = 194 Cr −1.094 age −0.287 (male), eGFR = 194 Cr −1.094 age −0.287 0.739 (female).…”

“…6,8) Diabetes mellitus was defined as a hemoglobin A1c level of !6.5% (as NGSP value) or medical treatment for diabetes mellitus or a history of diabetes mellitus. 6) We also calculated the estimated glomerular filtration rate (eGFR) from the serum creatinine level, age, weight, and gender using the following formula: eGFR = 194 Cr −1.094 age −0.287 (male), eGFR = 194 Cr −1.094 age −0.287 0.739 (female). 6,9) Peripheral arterial disease (PAD) was defined as an ankle brachial index of < 0.9 or medical treatment for PAD.…”