Trends and Clinical Outcomes in Patients Undergoing Primary Percutaneous Revascularisation for ST-Elevation Myocardial Infarction: A Single Centre Experience

Dawson, L.; Warren, Josephine; Mundisugih, Juan; Nainani, Viveka; Chan, William; Broughton, Archer; Taylor, Andrew J.; Walton, Antony; Duffy, Stephen J.; Shaw, James A.

doi:10.1016/j.hlc.2017.06.722

Cited by 3 publications

(1 citation statement)

References 35 publications

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“…Over the same time period, the age-adjusted 28-day and 1-year mortality rates for STEMI have not improved despite the documented increase in coronary angiography and revascularisation, the transition to more use of routine primary PCI and the other management advances in common with NSTEMI management. These trends are similar to other contemporary studies, although our absolute 28-day mortality rates were significantly higher because those studies contained only patients with STEMI who underwent PCI whereas we included all patients with STEMI admitted to New Zealand hospitals regardless of management disposition 28 29. One reason for this trend is that approximately two-thirds of the deaths included in 1-year mortality occurred within 28 days, compared with approximately one-third for NSTEMI, and early deaths are more difficult to reduce, particularly with medical therapy advances which take time to show efficacy.…”

Section: Discussionsupporting

confidence: 74%

Nationwide trends in acute coronary syndrome by subtype in New Zealand 2006–2016

Wang

Grey²,

Jiang

et al. 2019

Heart

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ObjectivesRecent studies in acute coronary syndrome (ACS) have reported mixed results for trends in ACS subtypes. The All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) 31 study evaluated trends in ACS event rates, invasive management and mortality of ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and unstable angina (UA) in New Zealand.MethodsAll ACS hospitalisations between 2006 and 2016 were identified from routinely collected national data and categorised into STEMI, NSTEMI, UA and MI unspecified (MIU). Annual hospitalisation, coronary procedure, 28-day and 1-year mortality rates were calculated and trends tested using Poisson regression adjusting for age and sex.ResultsOver the 11-year study period, there were 188 264 ACS admissions, of which 16.0% were STEMI, 54.5% NSTEMI, 25.7% UA and 3.8% MIU. Event rates of all ACS subtypes fell: STEMI by 3.4%/year, NSTEMI by 5.9%/year and UA by 8.5%/year, while the proportion of patients with ACS receiving angiography and revascularisation increased by 5.6% per year. Rates of percutaneous coronary intervention rose for STEMI, NSTEMI and UA, but coronary artery bypass grafting increased only for NSTEMI and UA. Mortality at 28 days and 1 year was higher for STEMI than NSTEMI and lowest for UA. There was a relative 1.6%/year decline in 1 year mortality for NSTEMI (p<0.001), but no significant change for STEMI and UA.ConclusionsWe observed declines in the event rates of all ACS subtypes and increases in revascularisation rates. The finding that mortality declined in patients with NSTEMI, but not in patients with STEMI and UA, despite increases in invasive procedures, requires further investigation.

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Section: Discussionsupporting

confidence: 74%

Nationwide trends in acute coronary syndrome by subtype in New Zealand 2006–2016

Wang

Grey²,

Jiang

et al. 2019

Heart

View full text Add to dashboard Cite

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A 10-year review of presentation, management and outcomes of STEMI in a high-volume regional tertiary Australian centre

Tierney,

Norman,

Al Ahmad

et al. 2024

International Journal of Cardiology

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Prediction of in-hospital mortality risk for patients with acute ST-elevation myocardial infarction after primary PCI based on predictors selected by GRACE score and two feature selection methods

Tang,

Liu,

et al. 2024

Front. Cardiovasc. Med.

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IntroductionAccurate in-hospital mortality prediction following percutaneous coronary intervention (PCI) is crucial for clinical decision-making. Machine Learning (ML) and Data Mining methods have shown promise in improving medical prognosis accuracy.MethodsWe analyzed a dataset of 4,677 patients from the Regional Vascular Center of Primorsky Regional Clinical Hospital No. 1 in Vladivostok, collected between 2015 and 2021. We utilized Extreme Gradient Boosting, Histogram Gradient Boosting, Light Gradient Boosting, and Stochastic Gradient Boosting for mortality risk prediction after primary PCI in patients with acute ST-elevation myocardial infarction. Model selection was performed using Monte Carlo Cross-validation. Feature selection was enhanced through Recursive Feature Elimination (RFE) and Shapley Additive Explanations (SHAP). We further developed hybrid models using Augmented Grey Wolf Optimizer (AGWO), Bald Eagle Search Optimization (BES), Golden Jackal Optimizer (GJO), and Puma Optimizer (PO), integrating features selected by these methods with the traditional GRACE score.ResultsThe hybrid models demonstrated superior prediction accuracy. In scenario (1), utilizing GRACE scale features, the Light Gradient Boosting Machine (LGBM) and Extreme Gradient Boosting (XGB) models optimized with BES achieved Recall values of 0.944 and 0.954, respectively. In scenarios (2) and (3), employing SHAP and RFE-selected features, the LGB models attained Recall values of 0.963 and 0.977, while the XGB models achieved 0.978 and 0.99.DiscussionThe study indicates that ML models, particularly the XGB optimized with BES, can outperform the conventional GRACE score in predicting in-hospital mortality. The hybrid models' enhanced accuracy presents a significant step forward in risk assessment for patients post-PCI, offering a potential alternative to existing clinical tools. These findings underscore the potential of ML in optimizing patient care and outcomes in cardiovascular medicine.

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Trends and Clinical Outcomes in Patients Undergoing Primary Percutaneous Revascularisation for ST-Elevation Myocardial Infarction: A Single Centre Experience

Cited by 3 publications

References 35 publications

Nationwide trends in acute coronary syndrome by subtype in New Zealand 2006–2016

Nationwide trends in acute coronary syndrome by subtype in New Zealand 2006–2016

A 10-year review of presentation, management and outcomes of STEMI in a high-volume regional tertiary Australian centre

Prediction of in-hospital mortality risk for patients with acute ST-elevation myocardial infarction after primary PCI based on predictors selected by GRACE score and two feature selection methods

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