Mortality In ST-elevation Myocardial Infarction Research Articles

Critical Time Intervals in Door-to-Balloon Time Linked to One-Year Mortality in ST-Elevation Myocardial Infarction

Background: Timely activation of primary percutaneous coronary intervention (PCI) is crucial for patients with ST-segment elevation myocardial infarction (STEMI). Door-to-balloon (DTB) time, representing the duration from patient arrival to balloon inflation, is critical for prognosis. However, the specific time segment within the DTB that is most associated with long-term mortality remains unclear. In this study we aimed to identify the target time segment within the DTB that is most associated with one-year mortality in STEMI patients. Methods: We conducted a retrospective cohort study at a tertiary teaching hospital. All patients diagnosed with STEMI and activated for primary PCI from the emergency department were identified between January 2013–December 2021. Patient demographics, medical history, triage information, electrocardiogram, troponin-I levels, and coronary angiography reports were obtained. We divided the DTB time into door-to-electrocardiogram (ECG), ECG-to-cardiac catheterization laboratory (cath lab) activation, activation-to-cath lab arrival, and cath lab arrival-to-balloon time. We used Kaplan-Meier survival analysis and multivariable Cox proportional hazards models to determine the independent effects of these time intervals on the risk of one-year mortality. Results: A total of 732 STEMI patients were included. Kaplan-Meier analysis revealed that delayed door-to-ECG time (>10 min) and cath lab arrival-to-balloon time (>30 min) were associated with a higher risk of one-year mortality (log-rank test, P < .001 and P = 0.01, respectively). In the multivariable Cox models, door-to-ECG time was a significant predictor for one-year mortality, whether it was analyzed as a dichotomized (>10 min vs ≤10 min) or a continuous variable. The corresponding adjusted hazard ratios (aHR) were 2.81 (95% confidence interval [CI] 1.42–5.55) for the dichotomized analysis, and 1.03 (95%CI 1.00–1.06) per minute increase, respectively. Cath lab arrival-to-balloon time also showed an independent effect on one-year mortality when analyzed as a continuous variable, with an aHR of 1.02 (95% CI 1.00–1.04) per minute increase. However, ECG-to-cath lab activation and activation-to-cath lab arrival times did not show a significant association with the risk of one-year mortality. Conclusion: Within the door-to-balloon interval, the time from door-to-ECG completion is particularly crucial for one-year survival after STEMI, while cath lab arrival-to-balloon inflation may also be relevant.

Mortality of ST-Elevation Myocardial Infarction (STEMI) in Mexico: Current Trends, Challenges, and Strategies for Improvement

ST-Elevation Myocardial Infarction (STEMI) remains a leading cause of cardiovascular mortality worldwide, with significant regional disparities. In Mexico, despite advances in healthcare systems and the availability of reperfusion therapies, STEMI continues to contribute substantially to cardiovascular-related deaths. This article reviews the mortality rates associated with STEMI in Mexico, focusing on epidemiological trends, barriers to optimal care, and regional healthcare inequalities. Key factors influencing outcomes include delayed diagnosis, limited access to percutaneous coronary intervention (PCI), socioeconomic determinants, and regional variability in healthcare infrastructure. Strategies to mitigate these challenges, such as strengthening prehospital care, expanding reperfusion networks, and addressing healthcare inequities, are discussed. This review underscores the urgent need for nationwide efforts to optimize STEMI management and reduce associated mortality.

Association of risk factors on mortality in ST-elevation myocardial infarction patients with diabetes mellitus: a systematic review and meta-analysis of cohort studies

Abstract Introduction Despite advancements in medical therapy and revascularization strategies for ST-elevation myocardial infarction (STEMI), diabetes mellitus (DM) remains independently associated with enhanced morbidity and mortality in STEMI. The causes for this are still unknown. Therefore, we aimed to summarise and quantify existing evidence in a systematic review and meta-analysis on the association between risk factors and mortality in STEMI patients with DM from prospective and retrospective cohort studies. Methods The systematic literature search was performed on the database of PubMed, Scopus and the Cochrane library up to July 2022. Relevant data were extracted and the risk of bias (RoB) of each study was assessed by using the Quality In Prognosis Studies (QUIPS) tool. All steps were conducted by two researchers independently. Summarised relative risks (SRR) and 95% confidence interval (CI) were estimated using a random effects model. I² was calculated as a measure of inconsistency. Results Out of 7601 studies, 18 were included after full-text screening, meeting our inclusion criteria. The RoB was moderate for 6 and high for 12 studies. Results of 7 studies reported on in-hospital mortality, 7 on all-cause-mortality up to 72 months, 3 on both outcomes, and 1 on cardiac death followed-up for 3.5 years. We found an increased risk of mortality for female compared to male sex (SRR [95% CI]: 1.56 [1.20; 2.01], n = 3 studies), age per 5 year increase (SRR [95% CI]: 1.26 [1.23; 1.30], n = 10 studies), admission blood glucose ≥ 7,8 mmol/l (SRR [95% CI]: 2.54 [1.60; 4.04], n = 3 studies), insulin treatment (SRR [95% CI]: 1.72 [1.33; 2.21], n = 2 studies), and dedicated Killip classification III-IV (SRR [95% CI]: 2.97 [2.58; 3.41], n = 3 studies) in STEMI patients with DM. Similar findings were observed for pre-existing comorbidities: prior myocardial infarction (SRR [95% CI]: 1.25 [1.06; 1.47], n = 3 studies), and heart failure (SRR [95% CI]: 2.68 [1.83; 3.93], n = 2 studies). Current smoking (SRR [95% CI]: 0.68 [0.52; 0.88], n = 3 studies) and hypercholesterinemia (SRR [95% CI]: 0.67 [0.57; 0.79], n = 2 studies) showed a reduced risk for mortality, while no association was found for multivessel disease (SRR [95% CI]: 1.03 [0.55; 1.92], n = 3 studies). Conclusion We identified specific risk factors of diabetes for mortality after STEMI. Our results confirm higher risk of mortality among STEMI patients with DM, particularly in women, older individuals, those with high admission blood glucose or insulin-dependent diabetes, and cardiac comorbidities. The role of smoking and hypercholesterinemia as a predictor for mortality might be explained by reverse causality and warrants further investigation.

Effects of Serum Potassium on Mortality in Patients With ST-Elevation Myocardial Infarction.

Disturbances in potassium levels can induce ventricular arrhythmias and heighten mortality in patients with ST-elevation myocardial infarction (STEMI). This study evaluates the influence of sK levels on seven-day mortality and incidence of ventricular arrhythmias in STEMI patients to further improve clinical guidelines and outcomes. This retrospective, propensity-matched study analyzed approximately 250,000 acute STEMI patients from 55 major academic medical centers/healthcare organizations (HCOs) in the US Collaborative Network of the TriNetX database. The sK levels recorded on the day of STEMI diagnosis were categorized into four cohorts: sK ≤ 3.4 (hypokalemia), 3.5 ≤ sK ≤ 4.5 (normal-control), 4.6 ≤ sK ≤ 5.0 (high-normal), and sK ≥ 5.1 (hyperkalemia). Patient cohorts were propensity-matched using linear and logistic regression for demographics. Outcomes of seven-day mortality, ventricular tachycardia (VT), and ventricular fibrillation (VF) were compared between these cohorts and the control group. The analysis showed hypokalemia was linked to significantly higher seven-day mortality (7.2% vs. 4.3%; RR 1.69; p<0.001), and increased rates of VT and VF. Similarly, hyperkalemia was associated with elevated mortality (12.7% vs. 4.6%; RR 2.76; p<0.001), VT, and VF rates. High-normal sK levels showed increased mortality (7.4% vs. 4.7%; RR 1.58; p<0.001), but unchanged VT or VF rates compared to the normal sK group. This comprehensive study highlights the correlation of sK levels with death in STEMI patients, revealing a nearly doubled risk of mortality with hypokalemia and almost triples with hyperkalemia. More notably, the mortality for STEMIs is higher for high-normal vs normal sK values. Additionally, hypokalemia and hyperkalemia were found to significantly elevate VT and VF risks.

The assessment of serum uric acid-to-HDL cholesterol ratio as a new predictor of mortality in ST-elevation myocardial infarction: a cross-sectional study

Aims: The objective of this study was to evaluate the predictive efficacy of the Uric Acid-to-High Density Lipoprotein Cholesterol Ratio (UHR) as a novel inflammatory and metabolic marker for mortality in patients with ST-segment Elevation Myocardial Infarction (STEMI).&#x0D; Methods: This retrospective, single-center, cross-sectional, observational study enrolled 1361 patients diagnosed with STEMI undergoing primary percutaneous coronary intervention (PPCI) from March 2021, to January 2022. The participants were categorized into two groups: those experiencing in-hospital mortality (n=100) and those without in-hospital mortality (n=1265).&#x0D; Results: In-hospital mortality occurred in 100 patients (7.3%). UHR was notably higher in the mortality group compared to the non-mortality group (23.6±14.9% vs. 15.3±6.9%, p

Systemic Immune-Inflammation Index and Systemic Inflammatory Response Index as Predictors of Mortality in ST-Elevation Myocardial Infarction.

(1) Background: The systemic inflammatory response index (SIRI; neutrophil count × monocyte/lymphocyte count), and the systemic immune-inflammation index (SII; platelet count × neutrophil count/lymphocyte count) are recently proposed biomarkers to assess the immune and inflammatory status. However, data on SIRI and SII are still relatively lacking and do not definitively and exhaustively define their role as predictors of an adverse prognosis in acute myocardial infarction (AMI). The aim of the present study was to evaluate SII and SIRI determinants as well as to assess SIRI and SII prognostic power in ST-elevation myocardial infarction (STEMI). (2) Methods: A total of 105 STEMI patients (74 males, 70 ± 11 years) were studied (median follow-up 54 ± 25 months, 24 deaths). (3) Results: The main determinants of SIRI and SII were creatinine and brain natriuretic peptide (BNP) (multivariate regression). Patients with higher SIRI (>75th percentile, 4.9) and SII (>75th percentile, 1257.5) had lower survival rates than those in the low SIRI/SII group (Kaplan-Meier analysis). Univariate Cox regression revealed that high SIRI and SII were associated with mortality (HR: 2.6, 95% CI: 1.1-5.8, p < 0.05; 2.2, 1-4.9, p ≤ 0.05, respectively); however, these associations lost their significance after multivariate adjustment. (4) Conclusions: SIRI and SII association with mortality was significantly affected by confounding factors in our population, especially creatinine and BNP, which are associated with both the inflammatory indices and the outcome.

Age and sex-related differences in epidemiology, treatment, and mortality of patients with ST-segment elevation myocardial infarction in Iran.

Few studies have investigated the characteristics of patients with ST elevation myocardial infarction (STEMI) according to age and sex in Iran. This study aims to investigate the risk factors profile, treatment, and mortality of STEMI based on age and sex. From 10th June 2016 to December 2019 a total of 2816, STEMI patients referred to the Imam Ali heart center of Kermanshah were included in the study. Profile of the risk factors, epidemiology, treatment and 30- day mortality for all cases in the age categories of 18-49, 50-64, and≥65 years were studied. There were 1256 (44.6%) middle-aged STEMI patients, and 2181 (77.45%) were male. The elderly had a longer median door-to-balloon and symptom-to-balloon time and received less primary PCI. In the absence of primary PCI, the rate of 30-day mortality in women was higher than in men, and the mortality rate increased with age. The risk of death in middle-aged women was higher than that of men. Also, in the middle-aged group, after multivariable adjustment, previous bypass surgery, diabetes, and Killip class≥2 was associated with significant increase in the risk of death. The present study showed that young people with STEMI had a high risk of heart failure and anterior infarction compared to the older age groups. Women had more risk factors for STEMI and a higher mortality rate than men. Therefore, there is a need to educate young age groups and women to modify their lifestyles and intervene in the risk factors of heart diseases.

Lower myocardial infarction and all-cause mortality with laparoscopic cholecystectomy compared withopen cholecystectomy.

Aim: We compared inpatient outcome data of open (OC) versus laparoscopic cholecystectomy (LC). Patients & methods: We used the National Inpatient Samples database from 2010-2014. Results: LC was done in 340,999 and OC in 68,529 OC patients. In 2010, ST-elevation myocardial infarction (STEMI) prevalence was 0.2 versus 0% (OR: 3.1, CI: 1.7-5.5; p<0.001), non-STEMI 1 versus 0.4% (OR: 2.5 CI: 2.0-3.0; p<0001), mortality 3.4 versus 0.4% (OR: 9.2, CI: 7.9-10.6; p<0001). After multivariate adjustment, OC remained independently associated with STEMI, non-STEMI and all-cause inpatient mortality (mortality multivariate OR: 6.4, CI: 5.5-7.4; p<0001, STEMI OR: 2.2. CI: 1.2-3.9; p=0.007, non-STEMI OR: 1.5, CI: 1.3-1.9; p<0001). Conclusion: OC is independently associated with STEMI, non-STEMIand all-cause inpatient mortality compared with LC.

Hematological biomarkers of troponin, neutrophil-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio serve as effective predictive indicators of high-risk mortality in acute coronary syndrome.

Assessing high-risk mortality in acute coronary syndrome (ACS) patients, encompassing ST-Elevation Myocardial Infarction (STEMI), Non-ST-Elevation Myocardial Infarction (NSTEMI), and Unstable Angina Pectoris (UAP), is crucial. However, the prognostic significance of hematological parameters in predicting high-risk mortality in ACS patients remains uncertain despite advancements in ACS research. The aim was to investigate prognostic significance of hematological parameters troponin, Creatine Kinase-MB (CKMB), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Monocyte-to-Lymphocyte Ratio (MLR), Basophil-to-Lymphocyte Ratio (BLR), and Eosinophil-to-Lymphocyte Ratio (ELR) levels in predicting high-risk mortality in ACS patients. In this retrospective observational study, data from medical records of 115 patients with ACS, including 40 with STEMI, 38 with NSTEMI, and 37 with UAP, were analyzed. Patients were selected using stratified random sampling, whereby five patients were randomly chosen each month from January 2021 to December 2022 while maintaining a 1:1:1 ratio of selection. Troponin (r = 0.519) and NLR (r = 0.484) showed moderate positive correlations with high-risk STEMI mortality. Meanwhile, troponin (r = 0.387), NLR (r = 0.279), PLR (r = 0.276), MLR (r = 0.250), BLR (r = 0.237), and ELR (r = -0.344) were found to be significantly correlated with high-risk ACS mortality. Troponin, CKMB, NLR, and MLR were significant (AUC>0.7) for high-risk STEMI mortality, and Troponin, NLR, and MLR were significant for high-risk ACS mortality. The results of the multivariate regression analysis indicated that only Troponin (OR:2.049; 95%CI: 1.802-8.218; p = 0.014), NLR (OR:1.652; 95%CI: 1.306-7.753; p = 0.030), and MLR (OR:4.067; 95%CI: 1.182-13.987; p = 0.026) were capable of predicting high-risk ACS mortality. Sub-group analysis showed an increased risk of ACS mortality by GRACE score >140 in patients with elevated levels of Troponin (OR:2.787; 95%CI: 1.032-7.524; p < 0.05), NLR (OR:3.287; 95%CI: 1.340-8.059; p < 0.05), and MLR (OR:4.156; 95%CI: 1.634-10.569; p < 0.05) above the cut-off value. Troponin, NLR, and MLR levels above the cutoff independently predict high-risk mortality in ACS.

Creatinine clearance is key to solving the enigma of sex difference in in-hospital mortality after STEMI: Propensity score matching and mediation analysis.

The precise impact of sex difference on in-hospital mortality in ST-elevation myocardial infarction (STEMI) patients are unclear, and the studies are no longer consistent. Therefore, we sought to evaluate the impact of sex differences in a cohort of STEMI patients. We analyzed the data of 2647 STEMI patients enrolled in the Kermanshah STEMI Cohort from July 2017 to May 2020. To accurately clarify the relationship between sex and hospital mortality, propensity score matching (PSM) and causal mediation analysis was applied to the selected confounder and identified intermediate variables, respectively. Before matching, the two groups differed on almost every baseline variable and in-hospital death. After matching with 30 selected variables, 574 male and female matched pairs were significantly different only for five baseline variables and women were no longer at greater risk of in-hospital mortality (10.63% vs. 9.76%, p = 0.626). Among the suspected mediating variables, creatinine clearance (CLCR) alone accounts for 74% (0.665/0.895) of the total effect equal to 0.895(95% CI: 0.464-1.332). In this milieu, the relationship between sex and in-hospital death was no longer significant and reversed -0.233(95% CI: -0.623-0.068), which shows the full mediating role of CLCR. Our research could help address sex disparities in STEMI mortality and provide a consequence. Moreover, CLCR alone can fully explain this relationship, which can highlight the importance of CLCR in predicting the short-term outcomes of STEMI patients and provide a useful indicator for clinicians.

The usefulness of initial serum ferritin level as a predictor of in-hospital mortality in STEMI.

Several studies have shown that elevated serum ferritin level is associated with a higher risk of coronary artery disease. Recently, it has been shown that high serum ferritin levels in men are independently correlated with an increased risk of cardiovascular mortality. This study aimed to investigate the possible correlation between the initial serum ferritin level and in-hospital mortality in patients presenting with ST-elevation myocardial infarction (STEMI). This retrospective cohort study included 890 patients who presented with acute STEMI and underwent successful primary percutaneous coronary intervention (PPCI) according to the standard techniques during the period from 1 May 2020 to 1 May 2021. At the time of admission, an initial serum ferritin level was measured in all patients. Comparison between initial ferritin levels was made between two groups: died and survived. Propensity matching was performed to exclude confounding factors effect. Forty-one patients had in-hospital mortality. There was no significant difference between both groups regarding baseline clinical characteristics. Initial serum ferritin levels were higher in deceased patients, even after propensity matching. In conclusion, even after propensity matching, initial ferritin levels were significantly higher in patients who died after being admitted for STEMI.

Cardiac rupture after ST elevation myocardial infarction – a decade's experience of a tertiary cardiology centre

Abstract Mechanical complications post ST elevation myocardial infarction (STEMI) are life-threating events, that require rapid recognition and appropriate management. Clinical diagnosis, considering high index of suspicion and bedside echocardiography should be considered in all STEMI patients Despite the overall decrease of the incidence of cardiac rupture (CR) secondary to STEMI in context of early revascularization and the wide availability of primary PCI, CR has still an unacceptable high mortality. Purpose To provide demographic, clinical, management and prognostic data associated to cardiac rupture from a tertiary centre of cardiology in Romania and to better describe in-hospital trajectory. The primary endpoint was defined as the incidence of CR and secondary endpoints were rate of surgical interventions, in-hospital mortality rate at 24 hours and after 24 hours during index hospitalization. Methods The analysis of the electronic medical records retrospectively identified 7703 patients admitted for STEMI between 01 Jan 2011 and 31 Dec 2020. A database consisting of demographic data, medical history, cv and non-cv comorbidities, in-hospital management were recorded using an UiPath robotic process automation (RPA) technology. Characteristics of the patients +/− CR were compared, and data analysis was performed using SPSS 26 Ed. Results Of a total number of 7703 consecutive STEMI patients, CR has been identified in 185 patients (mean incidence of 2.4%). The annual rates for CR incidence remained stable during the past decade (Figure 1). Patients with CR were older compared with non-CR (71.6±10.2 vs 61.47±12.8 years; p&amp;lt;0.001) and more commonly female (3.92% vs 1.78% males, p=0.04). The CR patients had more comorbidities and CV risk factors – HTN, smoker status, DLP, more AF, CKD, obesity and chronic cognitive deficit (p&amp;lt;0.05), but not DM (p=0.6). Among the CR group patients, anterior MI was the frequent localisation (52%), followed by inferior MI (17%), infero-lateral (23%) and RV involvement MI (6.4%). According to the type of the mechanical complication, patients developed free wall rupture (50% of cases), 39% IVS rupture and 11% papillary muscle was involved; A number of 50 patients (27%), benefited from emergent cardiac surgery and 31.3% of CR patients received mechanical circulatory support. The overall STEMI mortality in the first 24-hours was 1.84% and in most of these patients the main cause of death was related to CR (31%). Overall total in-hospital mortality was 8.08% (6.5% non-CR group vs. 70.8% the CR group – Figure 1). Conclusions The study presents the epidemiological characteristics of CR complicating STEMI in the largest tertiary cardiovascular hospital in Romania. We have identified a stable trend for the incidence of CR incidence among patients with STEMI. In spite of the high rate of cardiac surgery and MCS, in-hospital mortality remains very high, particularly in the first 24 h since admission Funding Acknowledgement Type of funding sources: None.

The Association Between Admission Heart Failure and In-Hospital Outcomes in ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention.

BackgroundThe Global Registry of Acute Coronary Events (GRACE) study showed that admission HF is associated with longer hospital stay and higher mortality in ST-elevation myocardial infarction (STEMI) patients. No data are available on the effect of heart failure (HF) on the length of cardiac care unit (CCU) stay and in-hospital major adverse cardiac events (MACEs). The link between the severity of HF and the in-hospital prognosis is not established. Therefore, we aimed to investigate the unstudied outcomes in HF patients as well as to compare the outcomes across the spectrum of HF presentations.MethodsWe studied 210 STEMI patients presenting to a single primary percutaneous coronary intervention (PPCI) center in a retrospective cohort pattern. We excluded those who received fibrinolysis, those who had chest pain for more than 24 h and those with previous stents and presenting with stent thrombosis. All the procedures followed the ethical standards of Alexandria University and the Helsinki Declaration.ResultsSTEMI patients with HF had significantly longer CCU stay (mean value of 3.6 vs. 2.87 days, P = 0.009), higher in-hospital MACE (55% vs. 4.7%, P < 0.001) and higher mortality (15% vs. 0.53%, P < 0.001). Multivariate logistic regression analysis revealed that HF is an independent predictor of in-hospital mortality (odds ratio (OR) = 9.11, 95% confidence interval (CI): 1.66 - 49.9, P = 0.01). The patients with severe HF on admission (Killip III and IV) tended to stay longer in the CCU (4.13 ± 1.89 days vs. 3.25 ± 1.54 days, P = 0.069) and the hospital (5.88 ± 3.09 vs. 4.42 ± 2.47 days, P = 0.077), compared to those with mild HF (Killip II). There was a tendency for a higher incidence of in-hospital MACE (75% vs. 33%, P = 0.068) and mortality (16.7% vs. 12.5%, P = 0.798) in the former group compared to the latter. The differences among HF subgroups did not reach the point of statistical significance though.ConclusionsThe presence of HF on the admission of STEMI patients undergoing PPCI is associated with longer CCU stay, higher in-hospital MACE and mortality.

Sex-related differences in the management and outcomes of patients hospitalized with ST-elevation myocardial infarction: a comparison within four European myocardial infarction registries.

AimsData on how differences in risk factors, treatments, and outcomes differ between sexes in European countries are scarce. We aimed to study sex-related differences regarding baseline characteristics, in-hospital managements, and mortality of ST-elevation myocardial infarction (STEMI) patients in different European countries.Methods and resultsPatients over the age of 18 with STEMI who were treated in hospitals in 2014–17 and registered in one of the national myocardial infarction registers in Estonia (n = 5817), Hungary (n = 30 787), Norway (n = 33 054), and Sweden (n = 49 533) were included. Cardiovascular risk factors, hospital treatment, and recommendation of discharge medications were obtained from the infarction registries. The primary outcome was mortality, in-hospital, after 30 days and after 1 year. Logistic and cox regression models were used to study the associations of sex and outcomes in the respective countries. Women were older than men (70–78 and 62–68 years, respectively) and received coronary angiography, percutaneous coronary intervention, left ventricular ejection fraction assessment, and evidence-based drugs to a lesser extent than men, in all countries. The crude mortality in-hospital rates (10.9–15.9 and 6.5–8.9%, respectively) at 30 days (13.0–19.9 and 8.2–10.9%, respectively) and at 1 year (20.3–28.1 and 12.4–17.2%, respectively) after hospitalization were higher in women than in men. In all countries, the sex-specific differences in mortality were attenuated in the adjusted analysis for 1-year mortality.ConclusionDespite improved awareness of the sex-specific inequalities on managing patients with acute myocardial infarction in Europe, country-level data from this study show that women still receive less guideline-recommended management.

Clinical profile and predictors of 30-day all-cause mortality of ST-elevation myocardial infarction (STEMI) patients receiving fibrinolytic therapy in an Asian population

BackgroundFibrinolysis remains the primary reperfusion strategy for ST-elevation myocardial infarction (STEMI) in many Asian countries. The outcomes and factors affecting mortality in STEMI fibrinolysis in the Asian population are lacking despite being widely used. ObjectivesThis study aimed to assess the clinical profile of patients and predictors affecting STEMI mortality in an Asian population. MethodsThis single-center retrospective study analyzed data from STEMI patients who received fibrinolytic therapy from 2016 to 2020 in a tertiary hospital. Logistic regression analysis was performed to identify the significant predictors of the 30-day all-cause mortality, the primary outcome. ResultsA total of 859 patients were included. Their mean age was 53.6 ±12.1 years and they were predominantly male (n=769, 89.4%). The majority of them had anterior involvement STEMI (n = 477, 55.5%) and presented with Killip ≥ II (n = 424, 49.4%). The 30-day all-cause mortality was 12.0% (n = 103). The final model found six predictors for 30-day mortality: age ≥75 (aOR 4.784, p < 0.001), female gender (aOR 2.869, p = 0.001), pre-existing hypertension (aOR 1.623, p = 0.046), anterior myocardial infarction (MI) (aOR 1.947, p < 0.001), Killip class (p < 0.001) and heart rate ≥100 at presentation (aOR 1.823, p = 0.016). Following fibrinolytic therapy, five predictors were found to affect 30-day mortality, i.e. failed fibrinolysis (aOR 2.094, p = 0.041), bleeding events, congestive heart failure (aOR 3.554, p = 0.046), ventricular fibrillation/ tachycardia (aOR 5.920, p < 0.001), and atrial fibrillation/ flutter (aOR 2.968, p = 0.016). ConclusionOur STEMI patients were younger and more ill at presentation. The risk predictors on 30-day all-cause mortality identified in our Asian population allow the clinicians to better triage and manage STEMI patients.

Comparison of Mortality Outcomes in Acute Myocardial Infarction Patients With or Without Standard Modifiable Cardiovascular Risk Factors

BackgroundAcute myocardial infarction (AMI) cases have decreased in part due to the advent of targeted therapies for standard modifiable cardiovascular disease risk factors (SMuRF). Recent studies have reported that ST-elevation myocardial infarction (STEMI) patients without SMuRF (termed “SMuRF-less”) may be increasing in prevalence and have worse outcomes than “SMuRF-positive” patients. As these studies have been limited to STEMI and comprised mainly Caucasian cohorts, we investigated the changes in the prevalence and mortality of both SMuRF-less STEMI and non-STEMI (NSTEMI) patients in a multiethnic Asian population.MethodsWe evaluated 23,922 STEMI and 62,631 NSTEMI patients from a national multiethnic registry. Short-term cardiovascular and all-cause mortalities in SMuRF-less patients were compared to SMuRF-positive patients.ResultsThe proportions of SMuRF-less STEMI but not of NSTEMI have increased over the years. In hospitals, all-cause and cardiovascular mortality and 1-year cardiovascular mortality were significantly higher in SMuRF-less STEMI after adjustment for age, creatinine, and hemoglobin. However, this difference did not remain after adjusting for anterior infarction, cardiopulmonary resuscitation (CPR), and Killip class. There were no differences in mortality in SMuRF-less NSTEMI. In contrast to Chinese and Malay patients, SMuRF-less patients of South Asian descent had a two-fold higher risk of in-hospital all-cause mortality even after adjusting for features of increased disease severity.ConclusionSMuRF-less patients had an increased risk of mortality with STEMI, suggesting that there may be unidentified nonstandard risk factors predisposing SMuRF-less patients to a worse prognosis. This group of patients may benefit from more intensive secondary prevention strategies to improve clinical outcomes.

Sex differences in treatment and outcomes of patients with in-hospital ST-elevation myocardial infarction.

Background and HypothesisTwo cohorts face high mortality after ST‐elevation myocardial infarction (STEMI): females and patients with in‐hospital STEMI. The aim of this study was to evaluate sex differences in ischemic times and outcomes of in‐hospital STEMI patients.MethodsConsecutive STEMI patients treated with percutaneous coronary intervention (PCI) were prospectively recruited from 30 hospitals into the Victorian Cardiac Outcomes Registry (2013−2018). Sex discrepancies within in‐hospital STEMIs were compared with out‐of‐hospital STEMIs. The primary endpoint was 12‐month all‐cause mortality. Secondary endpoints included symptom‐to‐device (STD) time and 30‐day major adverse cardiovascular events (MACE). To investigate the relationship between sex and 12‐month mortality for in‐hospital versus out‐of‐hospital STEMIs, an interaction analysis was included in the multivariable models.ResultsA total of 7493 STEMI patients underwent PCI of which 494 (6.6%) occurred in‐hospital. In‐hospital versus out‐of‐hospital STEMIs comprised 31.9% and 19.9% females, respectively. Female in‐hospital STEMIs were older (69.5 vs. 65.9 years, p = .003) with longer adjusted geometric mean STD times (104.6 vs. 94.3 min, p < .001) than men. Female versus male in‐hospital STEMIs had no difference in 12‐month mortality (27.1% vs. 20.3%, p = .92) and MACE (22.8% vs. 19.3%, p = .87). Female sex was not independently associated with 12‐month mortality for in‐hospital STEMIs which was consistent across the STEMI cohort (OR: 1.26, 95% CI: 0.94–1.70, p = .13).ConclusionsIn‐hospital STEMIs are more frequent in females relative to out‐of‐hospital STEMIs. Despite already being under medical care, females with in‐hospital STEMIs experienced a 10‐min mean excess in STD time compared with males, after adjustment for confounders. Adjusted 12‐month mortality and MACE were similar to males.

ST-Elevation Myocardial Infarction Outcomes: A United States Nationwide Emergency Departments Cohort Study.

Literature regarding trends in incidence and mortality of ST-elevation myocardial infarction (STEMI) in emergency departments (EDs) is limited. To study the trends of incidence and mortality of STEMI. Using the National Emergency Department Sample database in the United States, we identified all ED encounters for patients presenting with STEMI using International Classification of Diseases codes. A linear p-trend was used to assess the trends. Out of the 973 million ED encounters represented, 641,762 (65/100,000; mean age 69 [59-81] years, 35.8% female) adult patients were recorded with STEMI. Among the major complications associated with STEMI, a total of 49,401 (7.7%) had cardiac complications, which included acute heart failure (n=9361, 1.6%), ventricular tachycardia or fibrillation (n=12,267, 1.91%), conduction block (n=20,165, 3.1%), and cardiogenic shock (n=7608, 1.2%). There were 5675 (0.9%) patients recorded with cerebrovascular events, which included acute ischemic stroke among 5205 (0.8%) patients and 470 (0.1%) with transient ischemic attack. Acute kidney injury was recorded for 10,082 (1.6%) patients. The trend for incidence of STEMI in the ED had decreased from 7.76/10,000 in 2011 to 4.07/10,000 in 2018 (linear p-trend 0.0006). However, the yearly mortality of STEMI related to ED encounters had remained relatively steady: 7.56% in 2011 to 7.50% in 2018 (linear p-trend 0.2364). Despite the fact that the number of patients presenting to the ED with STEMI has been decreasing, the mortality trends have remained steady. Further research of in-hospital STEMI may yield opportunities to reduce the risk of complications, improve patient outcomes and decrease health care burden.

Hospitalizations and in-hospital outcomes in patients with ST-elevation myocardial infarction during the coronavirus disease 2019 pandemic: The Albanian experience.

Global studies report a significant decline in ST-elevation myocardial infarction (STEMI) related hospitalization rates during the coronavirus disease 2019 (COVID-19) pandemic outbreak. However, there have been several divergent reports on hospital outcomes. In this study, we aim to investigate the impact of the COVID 19 outbreak on hospitalizations because of STEMI and in-hospital outcomes in Albania. This was a retrograde study, collecting data for hospitalizations because of STEMI from March 9, (first COVID 19 case in our country) to April 30, 2020, (period of total lockdown) compared with the same period in 2019 at our center. The incidence rate ratio (IRR) was used to compare admissions because of STEMI and procedures and the risk ratio (RR) to compare mortality and other complication rates. Admissions for STEMI declined during the COVID-19 period from a total of 217 in 2019 to 156 in 2020 (-28.1%) representing IRR 0.719 (p=0.033). PCIs also reduced from 168 procedures in 2019 to 113 in 2020 (-33%), representing an IRR of 0.67, p=0.021. The time from symptom onset to arrival at our intensive care unit was significantly higher in 2020 compared to 2019 (925.6±1097 vs. 438.7±385 minutes, p<0.001). The STEMI death rate during the pandemic compared to the control period was significantly increased to 14.1% vs. 7.8% (RR=1.91 p=0.037, but with no significant increase in primary PCI-STEMI death rate (8.9% vs. 4.8% RR=1.85 p=0.217). Cardiogenic shock also increased during the pandemic to 21.2% from 12.4% in 2019 (RR=1.70 p=0.025). Hospitalizations and revascularization procedures for STEMI significantly reduced during the COVID-19 pandemic. We identified a substantial increase in the STEMI mortality rate and cardiogenic shock during the pandemic outbreak. Delayed timely reperfusion intervention might be responsible for the increased risk for complications.

A New Predictor of Mortality in ST-Elevation Myocardial Infarction: The Uric Acid Albumin Ratio.

Several studies have shown that high uric acid (UA) and low serum albumin (SA) values increase the risk of cardiovascular disease and mortality in ST-elevation myocardial infarction (STEMI). We determined whether the uric acid/albumin ratio (UAR) is a predictor of mortality in STEMI patients. All patients who presented at our center with a diagnosis of STEMI and underwent percutaneous intervention from 2015 to 2020 were screened consecutively; 4599 patients were included. A Cox proportional hazards model was used to evaluate UAR, and adjusted predictors obtained from laboratory findings and clinical characteristics contributed to mortality. Also, a regression model was presented with a directed acyclic graph (DAG). The median age of the patients was 58years (IQR [interquartile range]: 50-67); 3581 patients (77.9%) were male. The incidence of mortality in the entire patient group was 11.9%. Median follow-up duration of all groups was 42months. Multivariate Cox proportional regression (model-1) analysis showed age (increase 50 to 67years; HR [hazard ratio]: 1.34, 95% CI 1.18-1.52) and UAR (increase 1.15-1.73; HR: 1.33, 95% CI 1.16-1.52) were associated with mortality. UAR may be a prognostic factor for mortality in STEMI patients and an easily accessible parameter to identify high-risk patients.