Prognostic Significance of Biomarkers in Predicting in-Hospital All-Cause Mortality in Elderly Patients with Acute Myocardial Infarction

Abstract

Background: AMI is a common cause of death in elderly patients. Therefore, prognostic prediction has become crucially important part of the treatment process. Aim:We aimed to investigate prognostic significance of biomarkers and other clinical factors in predicting all-cause in-hospital mortality in patients older than 75 years with AMI.Materials and Methods: 2059 consecutive patients were retrospectively included in single center study. Participants were divided into groups based on their in-hospital mortality. The prognostic ability of biomarkers peak values was evaluated by using ROC curve and binary logistic regression analysis.Results: Among 2059 patients enrolled in this study, 1141 (55.4%) were woman, and 1060 (51.5%) were with a diagnosis of non-ST segment elevation myocardial infarction. The mean age (SD) of the study population was 81.97 (4.33) years. In-hospital mortality rate in our study was 13.3%. Peak Troponin I, BNP and hs-CRP concentrations were significantly higher in deceased patients (all p<0.01). The area under the ROC curve for Troponin I was 0.595, 0.653 for BNP and 0.664 for hs-CRP. BNP level >824.3 ng/l and hs-CRP level >78.7 g/l were disclosed as the best thresholds for mortality prediction in this age group. Using binary logistic regression, hs-CRP level >78.7 g/l (OR (95% CI), 2.68 (1.89-3.81)), stroke history (OR (95%CI), 2.3 (1.53-3.47)), BNP level >824.3 ng/l (OR (95% CI), 2.04 (1.43-2.91)), in-hospital bleeding complications (OR (95% CI), 2.04 (1.27-3.28)) were identified as strongest independent predictors of in-hospital all-cause mortality. Conclusion:In-hospital mortality in elderly patients with acute myocardial infarction is 13.3%. Troponin I is the least useful biomarker in predicting mortality. Increased levels of hs-CRP, BNP, stroke history and the presence of any in-hospital bleeding complications were identified as reliable predictors of in-hospital mortality in the elderly population with acute myocardial infarction.