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Predictors of mortality in ST-elevation MI patients: A prospective study.

ABSTRACT: We aimed to define factors predicting mortality in patients having ST elevation myocardial infarction (STEMI) who had Primary Percutaneous Coronary Intervention (PCI) in our setting.This is a prospective study on patients presenting to the emergency department with STEMI who underwent PCI during a 12-month period. Physiological parameters were calculated using the vital signs and age of patients. Time-based factors in the institutional protocol were collected. Univariate analysis was performed to define significant factors that affected mortality. Significant factors were then entered into a logistic regression model. Factors significantly affecting mortality were defined. Receiving operating characteristic curve was applied to define the best predictors of mortality.A total of 167 consecutive patients were studied; 128 (76.6%) were males. The mean (SD) age of the patients was 61.9 (12.8) years. The logistic regression model showed that significant factors were age (P?=?.002), Modified Shock Index, MSI (P?=?.028), systolic blood pressure (P?=?.028), and time between consultation and activation of catheter laboratory (P?=?.047). The cut-off points with best prediction of mortality were age of 71.5 years, systolic blood pressure of less than 95 mmHg, MSI of 0.85, and a time more than 3.5 minutes between consultation and activation of catheter laboratory.Our study shows that significant predictors of 30-days mortality of STEMI were age, systolic blood pressure on presentation, MSI, and the time between consultation and catheter laboratory activation. Improving prehospital resuscitation and activation of the catheter laboratory by emergency physicians may reduce mortality in our setting.

SUBMITTER: Zorbozan O

PROVIDER: S-EPMC5851714 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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Predictors of mortality in ST-elevation MI patients: A prospective study.

Zorbozan Onur O Cevik Arif A AA Acar Nurdan N Ozakin Engin E Ozcelik Hamit H Birdane Alparslan A Abu-Zidan Fikri M FM

Medicine 20180301 9

We aimed to define factors predicting mortality in patients having ST elevation myocardial infarction (STEMI) who had Primary Percutaneous Coronary Intervention (PCI) in our setting.This is a prospective study on patients presenting to the emergency department with STEMI who underwent PCI during a 12-month period. Physiological parameters were calculated using the vital signs and age of patients. Time-based factors in the institutional protocol were collected. Univariate analysis was performed t ...[more]

PMID: 29489667

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Project description:OBJECTIVE:We hypothesized that Displacement Encoding with Stimulated Echoes (DENSE) and feature-tracking derived circumferential strain would provide incremental prognostic value over the extent of infarction for recovery of segmental myocardial function. METHODS:Two hundred and sixty-one patients (mean age 59 years, 73% male) underwent MRI 2 days post-ST elevation myocardial infarction (STEMI) and 241 (92%) underwent repeat imaging 6 months later. The MRI protocol included cine, 2D-cine DENSE, T2 mapping and late enhancement. Wall motion scoring was assessed by 2-blinded observers and adjudicated by a third. (WMS: 1=normal, 2=hypokinetic, 3=akinetic, 4=dyskinetic). WMS improvement was defined as a decrease in WMS???1, and normalization where WMS?=?1 on follow-up. Segmental circumferential strain was derived utilizing DENSE and feature-tracking. A generalized linear mixed model with random effect of subject was constructed and used to account for repeated sampling when investigating predictors of segmental myocardial improvement or normalization RESULTS: At baseline and follow-up, 1416 segments had evaluable data for all parameters. Circumferential strain by DENSE (p?<?0.001) and feature-tracking (p?<?0.001), extent of oedema (p?<?0.001), infarct size (p?<?0.001), and microvascular obstruction (p?<?0.001) were associates of both improvement and normalization of WMS. Circumferential strain provided incremental predictive value even after accounting for infarct size, extent of oedema and microvascular obstruction, for segmental improvement (DENSE: odds ratio, 95% confidence intervals: 1.08 per -1% peak strain, 1.05-1.12, p?<?0.001, feature-tracking: odds ratio, 95% confidence intervals: 1.05 per -1% peak strain, 1.03-1.07, p?<?0.001) and segmental normalization (DENSE: 1.08 per -1% peak strain, 1.04-1.12, p?<?0.001, feature-tracking: 1.06 per -1% peak strain, 1.04-1.08, p?<?0.001). CONCLUSIONS:Circumferential strain provides incremental prognostic value over segmental infarct size in patients post STEMI for predicting segmental improvement or normalization by wall-motion scoring.

Dataset Information

Predictors of mortality in ST-elevation MI patients: A prospective study.

Publications

Predictors of mortality in ST-elevation MI patients: A prospective study.

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