scholarly journals Association between acute myocardial infarction-to-cardiac rupture time and in-hospital mortality risk: a retrospective analysis of multicenter registry data from the Cardiovascular Research Consortium-8 Universities (CIRC-8U)

2021 ◽  
Author(s):  
Kihei Yoneyama ◽  
Yuki Ishibashi ◽  
Yorihiko Koeda ◽  
Tomonori Itoh ◽  
Yoshihiro Morino ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Regression Analysis ◽  
Cardiac Surgery ◽  
Hospital Mortality ◽  
Retrospective Analysis ◽  
Registry Data ◽  
Rupture Time ◽  
Cardiac Rupture ◽  
Multicenter Registry

AbstractDespite the known association of cardiac rupture with acute myocardial infarction (AMI), it is still unclear whether the clinical characteristics are associated with the risk of in-hospital mortality in patients with AMI complicated by cardiac rupture. The purpose of this study was to investigate the association between the time of cardiac rupture occurrence and the risk of in-hospital mortality after AMI. We conducted a retrospective analysis of multicenter registry data from eight medical universities in Eastern Japan. From 10,278 consecutive patients with AMI, we included 183 patients who had cardiac rupture after AMI, and examined the incidence of in-hospital deaths during a median follow-up of 26 days. Patients were stratified into three groups according to the AMI-to-cardiac rupture time, namely the > 24-h group (n = 111), 24–48-h group (n = 20), and < 48-h group (n = 52). Cox proportional hazards regression analysis was used to estimate the hazard ratio (HR) and the confidence interval (CI) for in-hospital mortality. Around 87 (48%) patients experienced in-hospital death and 126 (67%) underwent a cardiac surgery. Multivariable Cox regression analysis revealed a non-linear association across the three groups for mortality (HR [CI]; < 24 h: 1.0, reference; 24–48 h: 0.73 [0.27–1.86]; > 48 h: 2.25 [1.22–4.15]) after adjustments for age, sex, Killip classification, percutaneous coronary intervention, blood pressure, creatinine, peak creatine kinase myocardial band fraction, left ventricular ejection fraction, and type of rupture. Cardiac surgery was independently associated with a reduction in the HR of mortality (HR [CI]: 0.27 [0.12–0.61]) and attenuated the association between the three AMI-to-cardiac rupture time categories and mortality (statistically non-significant) in the Cox model. These data suggest that the AMI-to-cardiac rupture time contributes significantly to the risk of in-hospital mortality; however, rapid diagnosis and prompt surgical interventions are crucial for improving outcomes in patients with cardiac rupture after AMI.

P5502Comparison of clinical characteristics and prognosis between non-octogenarians and octogenarians with cardiac troponin positive acute myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Soeda ◽  
M Ishihara ◽  
F Fujino ◽  
H Ogawa ◽  
K Nakao ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiac Troponin ◽  
Clinical Characteristics ◽  
St Segment Elevation ◽  
The Poor ◽  
St Segment ◽  
Universal Definition ◽  
Multicenter Registry

Abstract Background Cardiac troponin (cTn) is the preferred biomarker for the diagnosis of acute myocardial infarction (AMI). Octogenarians who presented cTn positive AMI are not usually recruited in clinical trials. Therefore, their clinical characteristics and prognosis are rarely investigated. Objective To study the characteristics and prognosis in octogenarians who presented cTn positive AMI. Methods and results The Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET) is a prospective and multicenter registry. A total of 3,283 consecutive AMI patients who were diagnosed by cTn-based criteria were included. The patients were divided into non-octogenarians (n=2,593) and octogenarians (n=690). Compared with non- octogenarians, octogenarians showed significantly lower incidence of diabetes mellitus (37.6% and 31.9%, p=0.006) and dyslipidemia (53.6% and 45.6%, p<0.001), and significantly higher incidence of hypertension (64.1% and 75.3%, p<0.001) and chronic kidney disease (38.7% and 68.7%, p<0.001). Octogenarians showed significantly longer onset to door time (p<0.001) and longer door to device time (p<0.001). Though, compared with non-octogenarians, octogenarians showed lower peak CK (2,506 and 1,926, p<0.001), LVEF was significantly lower in octogenarians (54.6% and 52.6%, p=0.005). The presentation of AMI was different between the two group. The incidence of ST-segment elevation MI (STEMI) was 70.7% in non-octogenarians and 62.0% in octogenarians. Non-STEMI with CK elevation and without CK elevation were 16.2% and 13.1% in non- octogenarians, and 20.9% and 17.1% in octogenarians. In-hospital mortality was higher in octogenarians (4.7% and 13.2%, P<0.001). Especially, octogenarians with STEMI and non-STEMI with CK elevation showed the highest in-hospital mortality. And octogenarians without CK elevation showed similar in hospital mortality with non-octogenarians with STEMI (Figure). Conclusions J-MINUET showed the poor prognosis of octogenarians who were diagnosed as AMI based on cTn. Acknowledgement/Funding None

Predicting hospital mortality in patients with acute myocardial infarction

1994 ◽  
Vol 3 (3) ◽  
pp. 168-176 ◽  
Author(s):  
M Funk ◽  
RL Pooley-Richards
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Coronary Angiography ◽  
Hospital Mortality ◽  
Logistic Regression Analysis ◽  
Severity Of Illness ◽  
Left Ventricular ◽  
Left Ventricular Ejection

BACKGROUND Patients who have a myocardial infarction are a heterogeneous group. If those at risk for early mortality could be readily identified, it would provide a more solid basis for management decisions. Although past research has explored factors associated with mortality, findings are inconsistent. Variables have also been combined into prognostic indices, but these tools have yet to be evaluated adequately. OBJECTIVES To determine factors predictive of hospital mortality in patients with acute myocardial infarction, and to examine the usefulness of two severity-of-illness indices. METHODS The medical records of 392 patients diagnosed with acute myocardial infarction who had undergone coronary angiography during 1989 at a university medical center were reviewed. RESULTS Overall mortality was 9.4% (n = 37). Logistic regression analysis demonstrated that history of myocardial infarction, cardiogenic shock, age, left ventricular ejection fraction, and the number of occluded coronary vessels were significantly associated with hospital mortality in patients with acute myocardial infarction. The two severity-of-illness indices were significant predictors of mortality, although sensitivity, specificity, and predictive values varied. A formula for determining the probability of mortality, based on logistic regression analysis, is also presented. CONCLUSIONS Five factors were found to predict hospital mortality. The two severity-of-illness indices were moderately useful in predicting mortality. Unlike previous indices that did not incorporate currently available diagnostic data, the new formula included data from coronary angiography and nuclear scans. Although this formula requires validation on independent samples of patients with myocardial infarction, the findings of this study advance clinicians' ability to predict patient outcome.

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