Impact of patient-related and treatment-related factors on in-hospital mortality of patients with ST-elevation myocardial infarction: Data of Russian Acute Coronary Syndrome Registry

Abstract

ObjectiveWe examined relationships between inpatient medical treatment, reperfusion therapy and in-hospital mortality among patients with ST-elevation myocardial infarction (STEMI) in Russia. MethodsClinical information about 25,682 patients with STEMI enrolled in the 2010–2011 registry was included retrospectively in the study. Performance of the key guideline-recommended treatment interventions was assessed. Timeliness of reperfusion therapy was evaluated with the help of the following ACC/AHA clinical measures (2008): Time to fibrinolytic therapy, Time to primary percutaneous coronary intervention (PCI) and Reperfusion therapy. Multivariate logistic and Cox's regression models were used to assess the relationship between different in-hospital treatment interventions and the risk of in-hospital death among patients with STEMI under the control of patient characteristics and comorbidities. ResultsThe average age of patients was 63 (55–74) years. 34% of patients were female. Survived patients differed significantly from deceased ones in the majority of demographic, anamnesis, clinical presentation and treatment parameters. Hospital treatment with ACE-Is or ARBs, β-blockers and statins was significantly associated (χ2=482.1, P<0.0001) with lower inpatient mortality. Prognostic value of reperfusion therapy and measures of its timeliness were not statistically significant (P≥0.05 for Wald test for each factor). ConclusionSTEMI treatment with ACE-Is or ARBs, β-blockers and statins during hospital stay (not necessarily at arrival) influences upon the rate of death in hospital as strong as the patient clinical status at admission. Reperfusion and its performance are additional factors that influence indirectly on the risk of in-hospital mortality in patients with STEMI.