ST-segment elevation myocardial infarction, systems of care. An urgent need for policies to co-ordinate care in order to decrease in-hospital mortality

We investigated the relation of initial metabolic acidemia to in-hospital mortality in patients treated with emergency coronary angioplasty for shock complicating first anterior ST-segment elevation myocardial infarction (STEMI). Methods A total of 23 consecutive patients (17 men, 73±12 years) with Killip class IV class due to anterior STEMI were studied. Using median levels of arterial base excess (BE, −5.8 mmol/L), the patients were divided into high and low BE groups, and both groups were compared regarding microvascular revascularization and clinical outcomes. To evaluate myocardial tissue-level reperfusion, severe microvascular injury was defined by the presence of both angiographic myocardial blush grade 0/1 and less than 30 % resolution of ST-elevation after angioplasty. Results In-hospital mortality was 92 % in the high BE group (−12.0±4.9 mmol/L) as compared with 9 % in the low BE group (−0.9±2.4mmol/L, p=0.0001 vs. high BE group). Baseline clinical and angiographic characteristics were not different between the two groups. Arterial gas analysis showed lower pH and higher levels of lactate in the high BE group than in the low BE group (7.22±0.16 vs. 7.42±0.06, p=0.006, 8.52±4.43 vs. 2.42±1.33, p=0.016). Despite successfully culprit angioplasty in all cases, the incidence of severe microvascular injury was significantly high in the high BE group as compared with the low BE group (83 vs. 36 %, p=0.018). Initial levels of BE showed a significant negative relation to ST-segment resolution (r=0.61, p=0.002). A multivariate regression analysis demonstrated a potent association of initial levels of BE with severe microvascular injury (r 2 =0.341, p=0.015). Conclusions We identified the pivotal association of initial metabolic crisis with severe microvascular reperfusion injury leading to high in-hospital mortality in patients with cardiogenic shock complicating STEMI.

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Comparing the Prognostic Value of Hematological Indices in Patients With ST Segment Elevation Myocardial Infarction: “A Head to Head” Analysis

Angiology ◽

10.1177/0003319720977754 ◽

2020 ◽

pp. 000331972097775

Author(s):

Serhat Sigirci ◽

Özgür Selim Ser ◽

Kudret Keskin ◽

Süleyman Sezai Yildiz ◽

Ahmet Gurdal ◽

...

Keyword(s):

Myocardial Infarction ◽

Mortality Rate ◽

Hospital Mortality ◽

Hematological Indices ◽

St Segment Elevation ◽

Lymphocyte Ratio ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Long Term Mortality

Although there are reviews and meta-analyses focusing on hematological indices for risk prediction of mortality in patients with ST segment elevation myocardial infarction (STEMI), there are not enough data with respect to direct to head-to-head comparison of their predictive values. We aimed to investigate which hematological indices have the most discriminatory capability for prediction of in-hospital and long-term mortality in a large STEMI cohort. We analyzed the data of 1186 patients with STEMI. In-hospital and long-term all-cause mortality was defined as the primary end point of the study. In-hospital mortality rate was 8.6% and long-term mortality rate 9.0%. Although the neutrophil to lymphocyte ratio (NLR) and age were found to be independent predictors of in-hospital mortality in the multivariate regression analyses; Cox regression analysis revealed that age, ejection fraction, red cell distribution width (RDW), and monocyte to high-density lipoprotein ratio (MHDLr) were independently associated with long-term mortality. Neutrophil to lymphocyte ratio had the highest area under curve value in the receiver operating characteristic curve analyses for prediction of in-hospital mortality. In conclusion, while NLR may be used for prediction of in-hospital mortality, RDW and MHDLr ratio are better hematological indices for long-term mortality prediction after STEMI than other most common indices.

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Difference in the in-hospital prognosis between ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction with high Killip class: Data from the Japan Acute Myocardial Infarction Registry

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872620926681 ◽

2020 ◽

pp. 204887262092668

Author(s):

Motoki Fukutomi ◽

Kensaku Nishihira ◽

Satoshi Honda ◽

Sunao Kojima ◽

Misa Takegami ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Mortality ◽

Short Term ◽

Term Outcome ◽

Killip Class ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Significant Difference

Background ST-segment elevation myocardial infarction is known to be associated with worse short-term outcome than non-ST-segment elevation myocardial infarction. However, whether or not this trend holds true in patients with a high Killip class has been unclear. Methods We analyzed 3704 acute myocardial infarction patients with Killip II–IV class from the Japan Acute Myocardial Infarction Registry and compared the short-term outcomes between ST-segment elevation myocardial infarction ( n = 2943) and non-ST-segment elevation myocardial infarction ( n = 761). In addition, we also performed the same analysis in different age subgroups: <80 years and ≥80 years. Results In the overall population, there were no significant difference in the in-hospital mortality (20.0% vs 17.1%, p = 0.065) between ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction groups. Patients <80 years of age also showed no difference in the in-hospital mortality (15.7% vs 15.2%, p = 0.807) between ST-segment elevation myocardial infarction ( n = 2001) and non-ST-segment elevation myocardial infarction ( n = 453) groups, whereas among those ≥80 years of age, ST-segment elevation myocardial infarction ( n = 942) was associated with significantly higher in-hospital mortality (29.3% vs 19.8%, p = 0.001) and in-hospital cardiac mortality (23.3% vs 15.0%, p = 0.002) than non-ST-segment elevation myocardial infarction ( n = 308). After adjusting for covariates, ST-segment elevation myocardial infarction was a significant predictor for in-hospital mortality (odds ratio 2.117; 95% confidence interval, 1.204–3.722; p = 0.009) in patients ≥80 years of age. Conclusion Among cases of acute myocardial infarction with a high Killip class, there was no marked difference in the short-term outcomes between ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction in younger patients, while ST-segment elevation myocardial infarction showed worse short-term outcomes in elderly patients than non-ST-segment elevation myocardial infarction. Future study identifying the prognostic factors for the specific anticipation intensive cares is needed in this high-risk group.

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463Temporal trends in latecomer ST-segment elevation myocardial infarction patients: Insights from the AMIS Plus Registry 1997–2017

European Heart Journal ◽

10.1093/eurheartj/ehz747.0122 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Roberto ◽

D Radovanovic ◽

L Biasco ◽

A Quagliana ◽

P Erne ◽

...

Keyword(s):

Myocardial Infarction ◽

Hospital Mortality ◽

Temporal Trends ◽

Late Presentation ◽

Evidence Based ◽

Absolute Rate ◽

Pharmacological Treatments ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment

Abstract Introduction A relevant proportion of patients experiencing ST-segment elevation myocardial infarction (STEMI) has a late presentation after symptoms onset. Temporal trends deriving from a large real-word scenario for this subgroup of patients are lacking. Purpose The aim of the present study was to provide a comprehensive analysis of temporal trends in latecomer STEMI patients, with particular regard to implementation of evidence-based treatments in this population and major in-hospital outcomes. Methods All STEMI patients included in the AMIS Plus Registry from January 1997 to December 2017 were included and patient-related delay was assessed: 27 231 patients were available for the final analysis. STEMI patients were classified as early or latecomers according to patient-related delay (≤ or >12 hours, respectively). Results 22 928 patients were earlycomers (84%) and 4303 patients were classified as latecomers (16%). Across the study period we observed a significant decrease in prevalence of late presentation from 22% to 12.3% (p<0.001, Figure 1). In latecomer STEMI patients there was a gradual uptake of evidence-based pharmacological treatments with an increase in discharge prescription of P2Y12 inhibitors from 6% to 90.7% (p<0.001). Similarly, a marked increase in percutaneous coronary intervention (PCI) rate was observed (12.1–86.6%; p<0.001). Across this 20-year period, in-hospital mortality was reduced to a third (to an absolute rate of 4.5%, p<0.001) and a significant reduction in prevalence of both cardiogenic shock (14.6–4.3%) and re-infarction (5.4–0.2%) during the index hospitalisation was observed (p<0.001 for both variables). Length of hospitalisation in acute care facilities significantly decreased from 10 (6,14) days to 4 (1,7) days (p<0.001). At multivariate analysis, PCI had a strong independent protective effect toward in-hospital mortality (odds ratio 0.3, 95% confidence interval 0.187 to 0.480). Figure 1 Conclusion The present study provides a comprehensive picture of temporal trends in late presentation in STEMI over the last 20 years in Switzerland. During the study period in latecomer STEMI population there was a gradual uptake of evidence-based pharmacological treatments and a marked increase in PCI rate. In-hospital mortality was reduced to a third (to an absolute rate of 4.5%) and this reduction seems to be mainly associated with the increasing implementation of PCI.

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The prediction of cardiac events in patients with acute ST segment elevation myocardial infarction: A meta–analysis of serum uric acid

Open Life Sciences ◽

10.1515/biol-2018-0050 ◽

2018 ◽

Vol 13 (1) ◽

pp. 413-421

Author(s):

Hailong Wang ◽

Jianjun Yang ◽

Jiang Sao ◽

Jianming Zhang ◽

Xiaohua Pang

Keyword(s):

Myocardial Infarction ◽

Uric Acid ◽

Hospital Mortality ◽

Serum Uric Acid ◽

Meta Analysis ◽

Systematic Analysis ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

One Year

AbstractObjectiveThe current study aimed to explore the predictive ability of serum uric acid (SUA) in patients suffering from acute ST segment elevation myocardial infarction (STEMI).MethodPubMed, EMBASE, Cochrane Library, and Medline databases were systematically searched from their respective inceptions to February 2018. Systematic analysis and random-effects meta–analysis of prognostic effects were performed to evaluate STEMI outcomes [i.e., in-hospital mortality, one-year mortality, in-hospital Major Adverse Cardiovascular Events (MACE)] in relation to SUA.ResultsA total of 12 studies (containing 7,735 patients with acute STEMI) were identified (5,562 low SUA patients and 3,173 high SUA patients). Systematic analysis of these studies showed that high SUA patients exhibited a higher incidence of in-hospital MACE (OR, 2.30; P < 0.00001), in-hospital mortality (OR, 3.03; P < 0.0001), and one-year mortality (OR, 2.58; P < 0.00001), compared with low SUA patients.ConclusionsAcute STEMI patients with high SUA exhibited an elevated incidence rate of in-hospital MACE, in-hospital mortality, and one-year mortality. Further randomized controlled trials will be needed to verify these results.

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