Mortality In STEMI Patients Research Articles

The effect of older age on receipt and outcomes of care in patients with acute coronary syndromes: a cohort study of 68,025 patients from the national acute coronary syndrome register of England/Wales

Purpose: To determine the effect of older age on receipt of care and mortality in STEMI patients from the national register of England and Wales. Methods: We analysed 68,025 patients between 2006 and 2010 using the Myocardial Ischaemia National Audit Project (MINAP) with one-year all-cause mortality follow-up. Results: Older patients were incrementally less likely to receive secondary prevention and primary reperfusion (angioplasty or thrombolysis)- OR (95% CI) for receiving reperfusion in patients over the 85 compared to those under 65 was 0.24 (0.23,0.25), OR for receiving statin was 0.31 (0.29,0.32). Reperfusion reduced mortality compared to medical treatment in all age groups, with a trend towards a reduced benefit for older patients. View this table: Impact of reperfusion on time to death ![Figure][1] Odds ratio for receipt of each treatment Conclusions: Older patients were less likely to receive treatment in ACS. There was less benefit from primary reperfusion with older age. [1]: pending:yes

Preponderant role of reduced early mortality in the reduction of one-year mortality in STEMI from 1995 to 2010: data from 4 French nationwide surveys over 15 years

Background and aim: Early mortality of STEMI patients has considerably decreased. We used the 1-year follow-up data from 4 nationwide French surveys conducted 5 years apart from 1995 to 2010 to determine whether survival also improved beyond the acute stage. Methods: USIK 1995, USIC 2000, FAST-MI 2005 and FAST-MI 2010 included patients with STEMI <48 hrs from symptom onset, over a 1-month period of time in most French cardiology centres (60 to 80% of all centres taking care of STEMI patients). In all, 6,704 patients participated (1995: 1,536; 2000: 1,841; 2005: 1,611; 2010: 1,716). Results: Mean age (66±14 to 63±15 years) and the overall risk profile of the population decreased. Reperfusion therapy use increased from 49% to 80%, with an increase in primary PCI (12% to 65%). Early use of antiplatelet agents (92 to 97%), LMWH (27% to 62%), beta-blockers (65% to 81%), ACE-I (48 to 60%), statins (10% to 90%), increased. One-year survival increased from 81.5% to 85.8% to 88.6% to 91.8% (adjusted HR, 95% CI for death 2010 vs 1995: 0.45, 0.36-057, P<0.001). This was mostly related to a major decrease in 30-day mortality (13.7% to 4.4%), while one-year mortality in 30-day survivors decreased to a much lesser extent (5.6% to 4.2%, adjusted HR 95% CI: 0.81, 0.56-1.17, P= 0.27) (Figure). Improvement in late mortality was more marked in patients with primary PCI (5.4% to 2.8%) and fibrinolytic therapy (5.4% to 2.2%) while it tended to deteriorate in patients with no reperfusion treatment (7.5% to 9.3%). ![Figure][1] Evolution of 1-year survival in STEMI Conclusion: Improvement in early mortality in STEMI patients is maintained at one year. Beyond the acute phase, however, the gain in survival (-25%) is more limited than the gain achieved in the first month (-65%), in spite of improved use of secondary prevention medications. [1]: pending:yes

The association between timeliness of reperfusion therapy, left ventricular function and in-patient mortality of STEMI patients presenting out of hours vs. working hours

The association between timeliness of reperfusion therapy, left ventricular function and in-patient mortality of STEMI patients presenting out of hours vs. working hours

White blood cell count and mortality in acute myocardial infarction

Introduction: Coronary atherosclerosis is increasingly viewed as an inflammatory process. We assessed the relation between WBC count on admission and mortality in STEMI patients treated with primary PCI. Material & Method: Totally 205 patients with STEMI less than 24 hours before admission who admitted for primary angioplasty enrolled in study. Study end points were defined as myocardial adverse cardiac event (MACE) and mortality at one month and one year follow-up. Result: Totally 205 patients (166 men) with mean age 56 ± 11 were enrolled in study. The mean WBC count was 8983 ± 34 and mean follow-up was 12.24 months. WBC count remained a significant predictor of mortality after multivariable adjustment in one month and 12 months follow-up (p = 0.02, p = 0.04). Conclusion: Our results extend previous find-ings that WBC count is an independent marker of cardiac mortality.

Abstract 18269: Invasive Treatment of ST-Elevation Acute Coronary Syndrome in Russian Hospitals is Predominantly Used in Lower Risk Patients

Introduction . Inhospital mortality of patients with ST-elevation (STE) acute coronary syndrome (ACS) in Russia is generally very high while it is reported to be low in patients subjected to primary percutaneous coronary interventions (pPCI) in invasive institutions. Hypothesis . Low mortality in STEMI patients treated with pPCI is at least partially explained by selection of patients with lower risk. Methods . To test this hypothesis we studied data from two independent Russian prospective ACS registries which were organized upon initiative of their participants - RECORD (2007-2008 years, 18 hospitals from 13 cities) and RECORD-2 (2009-2011 years, 7 hospitals from 7 cities). Results . There were 967 STEACS patients included in both registries (≥ 65 years - 41%, Killip class ≥ II - 21%). Hospitals with ability to apply invasive treatment (invasive hospitals) recruited 79% of patients. The rate of pPCI was 36% (in invasive hospitals - 46%). Rates of pPCI in invasive hospitals in patients aged ≥ 65 and &lt; 65 years were 33% and 54%, respectively (p&lt;0.0001); in patients with Killip class ≥ II and I - 34% and 49%, respectively (p=0.002); in patients with high and non-high risk of inhospital death according to GRACE score - 35% and 51%, respectively (p&lt;0.0001). Overall inhospital mortality was 11%. Rates of death in patients aged ≥ 65 and &lt; 65 years were 21% and 5%, respectively (p&lt;0.0001), in patients with Killip class ≥ II and I - 32% and 6%, respectively (p&lt;0.0001). Among patients aged 65 years and older inhospital mortality was significantly lower in those treated with pPCI than in patients treated without pPCI (11% and 23%, respectively, p=0.01). Among patients aged &lt; 65 years there was no significant difference in hospital mortality between patients subjected and not subjected to pPCI (5% in both groups, p=0.8). Conclusions . Data from limited size independent Russian ACS registries RECORD and RECORD-2 show that in high risk patients with STEACS (≥ 65 years old, Killip ≥ II, high risk by GRACE score) rate of pPCI was significantly lower than in non-high risk patients. However association of pPCI with lower hospital mortality was found only in patients aged ≥ 65 years.

Abstract 319: Prehospital Indication of Reperfusion in STEMI Patients and 1-Month Mortality

The indication of reperfusion at first medical contact (RFMC), proceeding directly to Cath-Lab (DCL) or, if not possible, performing pre-hospital thrombolisys on site (PhT), is a key action for STEMI patients. Our objective is to analyse if changes in RFMC are associated with one-month mortality in STEMI patients. Methods: Retrospective observational study of two periods, P1 (Jan2001-Dec03) and P2 (Jan2005-May2009), from a continuous pre-hospital registry of patients with STEMI. Patients were followed up in-hospital and one month later. Univariate analysis to compare both periods and logistic regression for one-month mortality (from in-hospital admission to one month later). Results: Total patients included 5522 (2248 P1 and 3274 P2). Univariate analysis (P1 vs P2) found significant differences in (%): age (64.3 vs 63.5, p=0.032), dyslipidemia (33.6 vs 36.7, p=0.02), hypertension (48.4 vs 53.1, p=0.01), history of angina (14.9 vs 11.1, p&lt;0.0001), history of AMI (16.4 vs 13, p=0.001), hypotension (systolic blood pressure&lt;90 mm Hg) (15.2 vs 13.3, p=0.049), Killip&gt;I (19 vs 12.7, p&lt;0.0001), onset-symptoms-call &lt;60 min. (56.5 vs 60.1, p=0.01), PhT (20.8 vs 40.4, p&lt;0.0001), DCL (0 vs 7.1, p&lt;0.0001), in-hospital thrombolysis (46.8 16.4, p&lt;0.0001) primary PCI (4.1 vs 17.5, p&lt;0.0001), rescue PCI (4.3 vs 12, p&lt;0.0001), PCI during hospital admission (16.9 vs 29.8, p&lt;0.0001), RFMC (20.8 vs 47.5, p&lt;0.0001),one-month mortality (18.8 vs 13.8 p&lt;0.0001). The logistic regression in table 1. After adjust for clinical conditions and any PCI treatment preformed, RFMC was associated with less one-month mortality. Conclusions: There were significant increases of RFMC and percentages of PCI throughout the process in P2. Despite the fact of worst clinical conditions of P1 patients, one-month mortality decreased in P2. RFMC was associated to one-month mortality reduction in STEMI patients.

525 The presence of mitral regurgitation is an independent predictor of 1-year mortality in STEMI patients with cardiogenic shock on admission

s S85 Eur J Echocardiography Abstracts Supplement, December 2006 Echocardiographic evaluation was focused on LV volumes, and indices of global (ejection fraction, global WMS) and regional function (WMSI for anterosepto-apical, posterior and inferior territories). Results: A different pattern of geographic distribution of dyssynergy was found between groups, despite similar end-diastolic volumes and global WMS. The degree of involvement of the posterior and inferior walls was the main determinant for the occurrence of mitral regurgitation see Table 1. Conclusions: Our results underscore the importance of posteroinferior wall asynergy over global remodeling and LV dysfunction for the occurrence of

ACC/AHA Clinical Performance Measures for Adults With ST-Elevation and Non–ST-Elevation Myocardial Infarction

Preamble......237 Medicine is experiencing an unprecedented focus on quantifying and improving health care quality. The American College of Cardiology (ACC) and the American Heart Association (AHA) have developed a multi-faceted strategy to facilitate the process of improving clinical care. The