Abstract
We aimed to identify independent predictors of cardiac mortality and hospitalization for heart failure (HHF) from a real-world, multi-ethnic Asian registry [the Singapore Myocardial Infarction Registry] of ST-segment elevation myocardial infarction (STEMI) patients treated by primary percutaneous coronary intervention. 11,546 eligible STEMI patients between 2008 and 2015 were identified. In-hospital, 30-day and 1-year cardiac mortality and 1-year HHF rates were 6.4%, 6.8%, 8.3% and 5.2%, respectively. From the derivation cohort (70% of patients), age, Killip class and cardiac arrest, creatinine, hemoglobin and troponin on admission and left ventricular ejection fraction (LVEF) during hospitalization were predictors of in-hospital, 30-day and 1-year cardiac mortality. Previous ischemic heart disease (IHD) was a predictor of in-hospital and 30-day cardiac mortality only, whereas diabetes was a predictor of 1-year cardiac mortality only. Age, previous IHD and diabetes, Killip class, creatinine, hemoglobin and troponin on admission, symptom-to-balloon-time and LVEF were predictors of 1-year HHF. The c-statistics were 0.921, 0.901, 0.881, 0.869, respectively. Applying these models to the validation cohort (30% of patients) showed good fit and discrimination (c-statistic 0.922, 0.913, 0.903 and 0.855 respectively; misclassification rate 14.0%, 14.7%, 16.2% and 24.0% respectively). These predictors could be incorporated into specific risk scores to stratify reperfused STEMI patients by their risk level for targeted intervention.
Highlights
We aimed to identify independent predictors of cardiac mortality and hospitalization for heart failure (HHF) from a real-world, multi-ethnic Asian registry [the Singapore Myocardial Infarction Registry] of ST-segment elevation myocardial infarction (STEMI) patients treated by primary percutaneous coronary intervention. 11,546 eligible STEMI patients between 2008 and 2015 were identified
A total of 11,546 STEMI patients reperfused by primary percutaneous coronary intervention (PPCI)
Around a third of the cohort had a history of diabetes (28.1%) and half had a history of hypertension (52.2%), dyslipidemia (46.0%) and were current smokers (49.1%). 4.0% suffered a cardiac arrest in the ambulance or on admission to the emergency department and 8.7% were in cardiogenic shock at presentation
Summary
We aimed to identify independent predictors of cardiac mortality and hospitalization for heart failure (HHF) from a real-world, multi-ethnic Asian registry [the Singapore Myocardial Infarction Registry] of ST-segment elevation myocardial infarction (STEMI) patients treated by primary percutaneous coronary intervention. 11,546 eligible STEMI patients between 2008 and 2015 were identified. It has a state-funded, mandatory, acute myocardial infarction (AMI) registry, called the Singapore Myocardial Infarction Registry (SMIR)[11], with a dedicated team to collect data from all hospitals We used this unbiased, real-world registry to determine independent variables on admission that would predict cardiac mortality during hospitalization, at 30-day and 1-year and 1-year hospitalization for heart failure (HHF) in patients presenting with a STEMI and reperfused by PPCI. Real-world registry to determine independent variables on admission that would predict cardiac mortality during hospitalization, at 30-day and 1-year and 1-year hospitalization for heart failure (HHF) in patients presenting with a STEMI and reperfused by PPCI These variables would subsequently be incorporated in risk scores to stratify reperfused STEMI patients by their risk level for targeted intervention early during hospitalization
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