Predictors of mortality in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Abstract

A cute coronary syndromes (ACS) are a major health problem and account for a large proportion of the total number of hospitalisations in the UK. The question as to whether and when revascularisation is indicated remains controversial and the choice of surgery or percutaneous coronary intervention (PCI) or continued medical treatment is often difficult. Such decisions are critically dependent on the clinician's ability to risk stratify patients at presentation and to calculate the risk of invasive treatments. Our study aimed at identifying those risk factors that predict an increased mortality following PCI for non-ST elevation ACS. METHODSThis was a retrospective outcome analysis of 630 sequential patients undergoing urgent PCI over a two year period (January 1999 to December 2000). All patients had the procedure during the same admission for unstable angina pectoris, non-ST elevation myocardial infarction, or unstable postinfarct angina. The chosen risk factors for mortality analysis were age, sex, ethnic group, hypertension, diabetes, hypercholesterolaemia, renal impairment, smoking, family history of ischaemic heart disease, previous myocardial infarction, any serious comorbidity, obstructive airways disease, peripheral vascular disease, number of vessels diseased, left ventricular (LV) function, and partial revascularisation. Cardiac troponin T was not routinely measured at our institution during the study period. A univariate analysis was performed to examine which variables were associated with early (30 day), medium (six months), and late (one year) mortality. Those found to be significant were then entered into a multiple logistic regression (forward linear) model. RESULTSUnivariate analysis showed age, hypercholesterolaemia, diabetes, impaired LV systolic function, multivessel disease, previous myocardial infarction, peripheral vascular disease, renal impairment, and partial revascularisation to affect one year mortality. Table 1 shows the results of multiple regression analysis for the key risk factors. Diabetes mellitus, impaired LV function, and peripheral vascular disease independently predicted death at one year. Partial revascularisation predicted death at six months and one year, whereas age > 65 predicted death at one, six, and 12 months.The one year mortality for the whole series was 6.8% (43 of 630) with an expected increase with age especially in patients over 75. One year mortality was as follows in the various age groups: age < 55, 0.8% (1 of 118); age 55-64, 1.1% (2 of 174); age 65-74, 6.2% (12 of 193), and age > 75 19.3%

Predictors of 6-month Mortality in Patients with Non-ST Elevation Acute Coronary Syndrome: A Study in Pakistani Population

“…Previously many studies have been conducted to investigate the predictors of mortality of patients presenting with AMI [ 6 – 11 ]. However, these studies were taken place in western populations with presumably ideal treatment and disease control.…”

Predictors of In-Hospital Mortality in Patients Admitted with Acute Myocardial Infarction in a Developing Country

“…Several studies in the USA and Europe have investigated the predictors of in-hospital mortality post-AMI [ 2 - 7 ]. Several variables were identified related to the clinical characteristics of the patients and their comorbidities [ 3 , 4 , 7 - 10 ].…”

“…Several studies in the USA and Europe have investigated the predictors of in-hospital mortality post-AMI [ 2 - 7 ]. Several variables were identified related to the clinical characteristics of the patients and their comorbidities [ 3 , 4 , 7 - 10 ]. Similar studies on AMI patients in developing countries are scarce [ 11 ], and little is known about the management and mortality rates of such patients in these countries [ 12 ].…”

Age‐Dependent Differences in Presentation, Risk Factor Profile, and Outcome of Suspected Acute Coronary Syndrome

“…Acute coronary syndrome (ACS) is common, and most patients with ACS are aged 65 and older 1 . Although this condition has been widely studied, older patients are underrepresented in the literature 2,3 . Numerous studies have shown that older patients with ACS have worse outcomes and that age is a major risk factor for a major acute coronary event 4–7 .…”