Predictors of 30-Day Mortality in the Era of Reperfusion for Acute Myocardial Infarction

Lee, Kerry L.; Woodlief, Lynn H.; Topol, Eric J.; Weaver, W. Douglas; Betriu, Amadeo; Col, Jacques; Simoons, Maarten L.; Aylward, Philip E.; Werf, Frans Van de; Califf, Robert M.

doi:10.1161/01.cir.91.6.1659

Cited by 953 publications

(343 citation statements)

References 48 publications

Supporting

Mentioning

312

Contrasting

Unclassified

Order By: Relevance

“…In the INTERHEART study, the strength of the association of hypertension with risk of first myocardial infarction (MI) was greater in women than in men [6]. Hypertension is also an important risk factor for death and ischemic events after presentation with acute coronary syndromes (ACS) [7].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of hypertension on short- and long-term prognoses in patients with ST elevation myocardial infarction and without previously known diabetes

et al. 2011

View full text Add to dashboard Cite

Hypertension is well established as a risk factor for the development of atherosclerosis. Data on the impact of hypertension in patients with ST elevation myocardial infarction are so far inconsistent, and are mainly related to studies performed in the thrombolytic era. We assessed the impact of hypertension over the short and long term in 560 patients with ST elevation myocardial infarction (STEMI) and without previously known diabetes, all of whom were submitted to mechanical revascularization and consecutively admitted to our Intensive Cardiac Care Unit. Hypertensive patients were older (p \ 0.001), more frequently male (0.005), and they showed a reduced eGFR (p \ 0.001).Smoking was more frequent in nonhypertensive patients (p \ 0.001), while the incidence of three-vessel coronary artery disease was higher in hypertensive patients (p = 0.003). No difference in the in-hospital mortality rates for the two subgroups was detected. At follow-up (median 32.5 months, 25th-75th percentile 16.9-47.3 months), Kaplan-Meier survival analysis detected no differences in mortality between hypertensive and nonhypertensive patients (log rank v 2 0.38, p = 0.538). According to our data, obtained from a large series of consecutive STEMI patients without previously known diabetes, all of whom were submitted to primary PCI, a history of hypertension does not affect mortality over either the short or the long term. Moreover, hypertensive patients showed an altered glucose response to stress, as indicated by higher admission glucose values, poorer in-hospital glucose control, and a higher incidence of acute insulin resistance (as indicated by the HOMA index). Hypertensive patients therefore appear to warrant careful metabolic management during their hospital courses.

show abstract

Section: Introductionmentioning

confidence: 99%

“…Data on the impact of hypertension in patients with ST elevation myocardial infarction (STEMI) are so far inconsistent, and are mainly related to studies performed in the thrombolytic era [7,[9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Impact of hypertension on short- and long-term prognoses in patients with ST elevation myocardial infarction and without previously known diabetes

et al. 2011

View full text Add to dashboard Cite

show abstract

“…It has been reported that admission heart rate (HR) values independently predict mortality in patients with ST-elevation acute myocardial infarction (STEMI). [1][2][3][4][5][6][7][8][9] Recently, Boersma et al identified HR as a significant predictor of 30-day mortality in patients with ACS without persistent ST-segment elevation. 10 However, there are no data regarding the long-term predictive value of the initial HR in patients with the full spectrum of ACS.…”

Section: Introductionmentioning

confidence: 99%

Does initial and delayed heart rate predict mortality in patients with acute coronary syndromes?

Kovar

Cannon

Bentley

et al. 2004

Clinical Cardiology

View full text Add to dashboard Cite

Background: Lower admission heart rate (HR) is known to predict favorable outcome in ST‐elevation acute myocardial infarction. However, there are limited short‐term and no long‐term data available regarding the prediction value of the initial HR in patients with the full spectrum of acute coronary syndromes (ACS). In addition, it is unknown whether the HR obtained later during hospitalization for ACS (i.e., Day 2 or 3) remains prognostically valuable. Hypothesis: The aim of this study was to investigate the utility of the initial and delayed HR in predicting outcome in patients with ACS. Methods: We examined mortality at 30 days and 10 months in 10,267 patients with ACS enrolled in the oral glycoprotein IIb/IIIa inhibition with Orofiban in Patients with Unstable coronary Syndromes‐Thrombolysis In Myocardial Infarction (OPUS‐TIMI) 16 trial. Patients were stratified by HR and day from onset of ACS into the following groups: (1) HR < 60 beats/min, (2) HR 60‐80 beats/min, (3) HR 80‐100 beats/min, (4) HR > 100 beats/min; and HR obtained on (1) Day 1, (2) Day 2, and (3) Day 3. Results: By univariate analysis, mortality at 30 days and at 10 months increased progressively with higher HR strata (1.4 vs. 1.6 vs. 2.3 vs. 5.6%, p < 0.001, and 2.6 vs. 4.2 vs. 6.5 vs. 11.8%, p < 0.001, respectively). Elevated HR remained associated with mortality irrespective of time from onset of ACS. Conclusions: Higher initial and delayed HR is highly predictive of higher short‐ and long‐term mortality in patients with ACS. This is a simple marker that could be easily used in risk assessment.

show abstract

“…Indeed, Lee et al demonstrated in the GUSTO‐I (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries‐I) that both heart rate and BP are among 5 predictors of 30‐day mortality after acute myocardial infarction 23. Contemporary findings in the field of cardiology showed similar results; in a cohort of 7187 patients with ST‐segment elevation–myocardial infarction, admission SI ≥0.7 was also associated with 1.6‐ and 1.5‐fold increased risk of 7‐ and 30‐day major adverse cardiovascular events, respectively 5…”

Section: Discussionmentioning

confidence: 99%

Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke

Myint

Sheng

Xian

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundThe prognostic value of shock index (SI), heart rate divided by systolic blood pressure, in stroke for clinical outcomes other than mortality is not well understood.Methods and ResultsWe examined the Get With The Guidelines–Stroke (GWTG‐Stroke) data to explore the usefulness of SI in predicting in‐hospital outcomes in 425 808 acute stroke cases (mean age: 71.0±14.5 years; 48.8% male; 89.7% ischemic stroke and 10.3% intracerebral hemorrhage) admitted between October 2012 and March 2015. Compared with patients with SI of 0.5 to 0.7, patients with SI >0.7 (13.6% of the sample) had worse outcomes, with adjusted odds ratios of 2.00 (95% confidence interval [CI], 1.92–2.08) for in‐hospital mortality, 1.46 (95% CI, 1.43–1.49) for longer length of hospital stay >4 days, 1.50 (95% CI, 1.47–1.54) for discharge destination other than home, 1.41 (95% CI, 1.38–1.45) for inability to ambulate independently at discharge, and 1.52 (95% CI, 1.47–1.57) for modified Rankin Scale score of 3 to 6 at discharge. Results were similar when analyses were confined to those with available National Institutes of Health Stroke Scale (NIHSS) or within individual stroke subtypes or when SI was additionally included in the models with or without blood pressure components. Every 0.1 increase in SI >0.5 was associated with significantly worse outcomes in linear spline models. The addition of SI to existing GWTG‐Stroke mortality prediction models without NIHSS demonstrated modest improvement, but little to no improvement was noted in models with NIHSS.Conclusions SI calculated at the point of care may be a useful prognostic indicator to identify those with high risk of poor outcomes in acute stroke, especially in hospitals with limited experience with NIHSS assessment.

show abstract

Predictors of 30-Day Mortality in the Era of Reperfusion for Acute Myocardial Infarction

Cited by 953 publications

References 48 publications

Impact of hypertension on short- and long-term prognoses in patients with ST elevation myocardial infarction and without previously known diabetes

Impact of hypertension on short- and long-term prognoses in patients with ST elevation myocardial infarction and without previously known diabetes

Does initial and delayed heart rate predict mortality in patients with acute coronary syndromes?

Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke

Contact Info

Product

Resources

About