Twelve-Year History of STEMI Management in Tehran Heart Center: Concomitant Reduction of In-Hospital Mortality and Hospitalization Length

Abstract

Background: Cardiovascular-related death remains the major cause of mortality in Iran despite significant improvements in its care. In the present study, we report the in-hospital mortality, hospitalization length, and treatment methods for patients with STelevation myocardial infarction (STEMI) in Tehran Heart Center (THC). Methods: Records pertaining to patients with STEMI from March 2006 to March 2017 were extracted from the databases of THC. Besides a description of temporal trends, multivariable regression analysis was used to find factors associated with in-hospital mortality. Results: During the study period, 8,295 patients were admitted with STEMI with a mean age of 60.4 ± 12.5 years. Men accounted for 77.5% of the study population. Hospitalization length declined from 8.4 to 5.2 days, and in-hospital mortality was reduced from 8.0% to 3.9% (both P values < 0.001). In a multivariable model adjusted for age, sex, conventional cardiac risk factors, prior cardiac history, and indices of event severity, primary percutaneous coronary intervention (PCI) (OR: 0.280, 95% CI: 0.186 to 0.512; P<0.001), coronary artery bypass graft (CABG) surgery (OR: 0.482, 95% CI: 0.220 to 0.903; P=0.025), and rescue or facilitated PCI (OR: 0.420, 95% CI: 0.071 to 0.812; P=0.001) were all associated with reduced in-hospital mortality in comparison with medical treatment. Furthermore, primary PCI was a crucial protective factor against prolonged length of hospital stay (OR: 0.307, 95% CI: 0.266 to 0.594; P<0.001). Conclusion: In-hospital mortality and hospitalization length were almost halved during the study period, and primary PCI has now replaced thrombolysis in the management of STEMI.

Reperfusion Therapy and Predictors of 30-Day Mortality after ST-Segment Elevation Myocardial Infarction in a University Medical Center in Western Iran

“…29 In line with our results, in-hospital STEMI mortality rate in Tehran Heart Center (another PPCIcapable hospital in Iran) was 5.4% and reduced from 8% to 3.9% during 2006-2017, mainly due to the improvement of reperfusion therapies. 30 Secondly, we did not have data on all of the factors associated with 30-day mortality, as well as unmeasured confounding variables that may be present in any observational studies. Thirdly, as an observational study, we acknowledge information bias such as exposure identification bias and misclassification, especially about self-reported variables.…”

Long-Term Hospital Readmission after ST-Elevation Myocardial Infarction: A 3-Year Follow-up from the SEMI-CI Study

“… 1 , 2 In Iran, the 12-year trend of in-hospital mortality and hospital length of stay for STEMI has decreased, and primary percutaneous coronary intervention (PCI) has replaced thrombolysis in the management of patients; nonetheless, the outcome of this group of patients is different from that in other countries. 3 Risk factors play an important role in the early onset of the disease at a younger age. Therefore, identifying risk factors and their management over time can help control the disease.…”