Prognostic Scale to Stratify Risk of Intrahospital Death in Patients with Acute Myocardial Infarction with ST Segment Elevation

Abstract

INTRODUCTIONThe scales available to predict death and complications after acute coronary syndrome include angiographic studies and serum biomarkers that are not within reach of services with limited resources. Such services need specifi c and sensitive instruments to evaluate risk using accessible resources and information.OBJECTIVE Develop a scale to estimate and stratify the risk of intrahospital death in patients with acute ST-segment elevation myocardial infarction.METHODS An analytical observational study was conducted in a universe of 769 patients with acute ST-segment elevation myocardial infarction who were admitted consecutively to the Camilo Cienfuegos Provincial Hospital in Sancti Spíritus Province, Cuba, from January 2013 to March 2018. The fi nal study cohort included 667 patients, excluding 102 due to branch blocks, atrial fi brillation, drugs that prolong the QT interval, low life expectancy or history of myocardial infarction. The demographic variables of age, sex, skin color, classic cardiovascular risk factors, blood pressure, heart rate, blood glucose level, in addition to duration and dispersion of the QT interval with and without correction, left ventricular ejection fraction, and glomerular fi ltration rate were included in the analysis. Patients were categorized according to the Killip-Kimball Classifi cation for degree of heart failure. A risk scale was constructed, the predictive ability of which was evaluated using the detectability index associated with an receiver-operator curve.RESULTS Seventy-seven patients died (11.5%). Mean blood glucose levels were higher among the deceased, while their systolic and diastolic blood pressure, left ventricular ejection fraction, and glomerular fi ltration rate were lower than those participants discharged alive. Relevant variables included in the scale were systolic blood pressure, Killip-Kimball class, cardiorespiratory arrest, glomerular fi ltration rate, corrected QT interval dispersion, left ventricular ejection fraction, and blood glucose levels. The variable with the best predictive ability was cardiorespiratory arrest, followed by a blood glucose level higher than 11.1 mmol/L. The scale demonstrated a great predictive ability with a detectability index of 0.92. CONCLUSIONSThe numeric scale we designed estimates and stratifi es risk of death during hospitalization for patients with ST-segment elevation myocardial infarction and has good metric properties for predictive ability and calibration.

Emerging Biomarkers for Predicting Clinical Outcomes in Patients with Heart Disease

“…APG was shown to be associated with in-hospital outcomes. A study of 667 patients admitted with first STEMI reported that APG ≥11.1 mmol/L was the second-best predictor of in-hospital mortality after cardiac arrest [ 40 ]. Similarly, a study of 1168 Black Africans with ACS [ 41 ] reported that elevated APG was associated with in-hospital mortality at an even lower threshold (>7.8 mmol/L).…”

“… Biomarker Details Outcome(s) Follow-up n Predictor/Cut-Off Value Risk [95% CI] Ref. APG STEMI/NSTEMI + PCI; no known DM MACE: death, MI, HF, or stroke 180 days 5309 7.0–11.0 mmol/L vs. <6.1 mmol/L (126–198 mg/dL vs. <110 mg/dL) OR 1.62 [1.14–2.29] [ 42 ] >11 mmol/L vs. <6.1 mmol/L (>198 mg/dL vs. <110 mg/dL) OR 3.59 [1.99–6.50] STEMI/NSTEMI + PCI; known DM Higher OR 2.42 [1.71–3.42] ACS ± DM (Black Africans) Mortality In-hospital 1168 >7.8 mmol/L (>140 mg/dL) HR 2.33 [1.44–3.77] [ 41 ] ACS, no DM (Black Africans) 836 HR 3.12 [1.72–5.68] First STEMI, no PCI Mortality In-hospital 667 ≥11.1 mmol/L (≥200 mg/dL) OR 2.62 [1.74–3.93] [ 40 ] Higher HR 3.17 [2.46–4.09] ...…”

Correlation between Selection of Time Window for Acute Cerebral Infarction and Efficacy of Intravascular Stent Implantation

“…Clinical studies have found that there are two categories of outcomes faced by nerve cells corresponding to ACI, namely, cell necrosis and apoptosis, in which cell necrosis corresponds to neurons in a hypoxic state for up to 5 min, and apoptosis to ischemic penumbra cells, with lagging death time. According to the current findings, it is known that the pathological process of ACI includes loss of ionic balance, energy failure, activation of free radicals, and glial cell activation, so the later the intervention is initiated, the greater the degree of neurocellular pathophysiological alterations at the time of blood perfusion recovery [ 24 ]. The study findings showed that the time window was positively correlative with the mRS score, namely, the larger the time window, the higher the mRS score and the worse the clinical prognosis of patients.…”