P1722A new predictive score for mortality and cardiogenic shock in patients with ST-elevation myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
B Picarra ◽  
J A Pais ◽  
A R Santos ◽  
M Carrington ◽  
D Bras ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
High Rate ◽  
Predictive Score ◽  
Predictive Capacity ◽  
End Point ◽  
Group A ◽  
St Elevation ◽  
Group B

Abstract Introduction Acute Myocardial Infarction with ST elevation (STEMI) presents a high rate of potentially fatal complications and in-hospital mortality. Objective To test the predictive capacity for Cardiogenic Shock (CS) and In-hospital Mortality (MIH) of a new risk score in patients (Pts) with STEMI. Population and methods Evaluated 5765 Pts with STEMI without CS at admission. The new score, was derived by previous studies in this population, and was calculated according to the following criteria: age ≥65 years (1 point), heart rate ≥100bpm (2 points), systolic blood pressure <100mmHg (2 points), blood glucose at admission above 180 mg/dL (1 point) and creatinine at admission >1.5mg/dL (2 points). The population was divided into three subgroups: group A low score (0–2 points), group B intermediate score (3–5 points) and group C score (6–8 points). The endpoints defined were CS during hospitalization, in-hospital mortality and combined end-point of MIH and CS. The relationship between each of the possible scores (from 0 to 8) and the various end-points was determined, and the sensitivity and specificity of the score as a predictor of MIH and CS was defined as the area under the ROC curve (ASC). Results After the application of the score, 3 subgroups were obtained: group A with 4819 Pts (83,6%), group B with 884 Pts (15,3%) and group C 62 Pts (1,1%). Patients of group C had a higher MIH (Group C: 45,2% vs B: 11,4% vs A: 2,0%, p<0,001), higher CS (C: 29,5% vs B: 12,0% vs A: 2,3%, p<0,001) and a higher combined end-point of MIH and CC (C: 53,2% vs B: 17,8% vs A: 3,4%, p<0,001) during hospitalization. The proposed score revealed a high predictive capacity of MIH (ASC 0,802, 95% CI 0,775–0,830, p=0,001), of CS (ASC 0,763, 95% CI 0,731–0,795, p=0,001) and for the combined endpoint (MIH and CC) ASC 0,781, 95% CI 0,756–0,806, p=0,001). The logistic regression models showed that Pts with a high score (group C) presented a 41-fold higher risk of MIH (OR 41,3; p<0,001) and 18-fold higher CS (OR 18,0; p<0.001) than patients with low score (group A). It was also found that the risk associated with an increase in one point score unit was 100% (OR 2,0 p<0.001) for MIH and 82% (OR 1,82, p<0,001) for CS. Conclusion This new score, with the use of practical and friendly variables, demonstrated a high predictive capacity of MIH and CS.

scholarly journals Cardiogenic shock and radial access in patients with an acute ST elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Zahn ◽  
M Hochadel ◽  
B Schumacher ◽  
M Pauschinger ◽  
C Stellbrink ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
St Elevation Myocardial Infarction ◽  
Strong Variation ◽  
Access Site ◽  
Femoral Access ◽  
Radial Access ◽  
St Elevation ◽  
The Difference

Abstract Background Cardiogenic shock (CS) in patients (pts) with acute ST elevation myocardial infarction (STEMI) is the strongest predictor of hospital mortality. Radial in contrast to femoral access in STEMI pts might be associated with a lower mortality. However, little is known on radial access in CS pts. Methods We retrospectively analysed all STEMI pts between 2009 and 2015 who sufferend from CS and who were included into the ALKK PCI registry. Pts treated via a radial access were compared to those treated via a femoral access. Results Between 2009 and 2015 23796 STEMI pts were included in the registry. 1763 (7.4%) of pts were in CS. The proportion of radial access was 6.6%: in 2009 4.0% and in 2015 19.6%, p for trend &lt;0.0001 with a strong variation between the participating centres (0% to 37%). Conclusions Radial access was only used in 6.6% of STEMI pts presenting in CS. However, a significant increase in the use of radial access was observed over time (2009: 4%, 2015 19.6%, p&lt;0.001), with a great variance in its use between the participating hospitals. Despite similar pt characteristics the difference in hospital mortality according to access site has to be interpretated with caution. Funding Acknowledgement Type of funding source: None

P3123Enoxaparin versus unfractionated heparin in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Graca Santos ◽  
R Ribeiro Carvalho ◽  
F Montenegro ◽  
C Ruivo ◽  
J Correia ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Propensity Score ◽  
Major Bleeding ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Group A ◽  
St Elevation ◽  
Group B

Abstract Background The use of intravenous enoxaparin (LBWH) in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) was upgraded in the latest European Guidelines to a class IIa recommendation. Purpose The authors aim to compare safety and prognostic impact of LMWH versus unfractionated heparin (UFH) use in STEMI patients undergoing primary PCI. Methods Retrospective study of 3875 STEMI patients who underwent pPCI between October 2010 and September 2017 and were included in a national multicenter registry. Group A consisted of patients managed only with LMWH, and Group B patients were treated with UFH regardless of eventual LMWH associated exposure. The groups were compared according to their demographic, clinical and laboratory characteristics. The primary endpoint (PE) results from a composite which included: procedural failure (pPCI failure or bailout use of GPIIb/IIIa inhibitors), in-hospital mortality, re-infarction or major bleeding (according to the registry criteria). The secondary endpoint (SE) included: in-hospital major bleeding, need for red blood cell transfusion, or haemoglobin drop ≥2g/dL. A 1:1 propensity score (PS) analysis was performed according to demographic variables, medical history and previous medication, physical examination, electrocardiogram characteristics and left ventricular function, matching 1558 of the 3875 patients for later comparison between groups. Results Overall, Group A included 1083 (27.9%) and Group B 2792 (72.1%) patients. The mean age was 63±14 years, and 33.5% of the cohort were female. Despite the baseline characteristics heterogeneity between groups, this phenomenon was not observed after PS matching. The PE was more frequent in Group A, without reaching statistical relevance (15.6% vs 13.3%, p=0.07). The SE was superior in Group A (34.4 vs 29.4%, p=0.01). According to the PS matching analysis, there were no differences beetween groups in terms of the PE (13.9% vs 12.0%, p=0.28), while the SE kept more frequent among Group A (34.9% vs 28.5%, p=0.02) [Figure]. Propensity score: group comparison Conclusion In this study based on a national multicentric registry of STEMI patients, the use of LMWH was not associated with better in-hospital prognosis in terms of major cardiovascular events and was related with higher rates of bleeding related events in the scenario of pPCI, compared to UFH. According to these results, further studies are required to support the widespread use of LMWH in this clinical scenario.

P264 Comparison of in-hospital mortality between acute inferior wall STEMI patients with right ventricular infarction and without right ventricular infarction undergoing a primary PCI in KCMH

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
S Preechawuttidej ◽  
S Srimahachota
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Right Ventricular ◽  
St Elevation Myocardial Infarction ◽  
Hospital Death ◽  
Inferior Wall ◽  
Right Ventricular Infarction ◽  
St Elevation ◽  
Ventricular Infarction

Abstract Background Patients with acute inferior wall ST elevation myocardial infarction, if there is a right ventricular myocardial infarction involvement, they have pretended a worse prognosis with hemodynamic and electrophysiologic complications causing higher in-hospital morbidity and mortality. However most patients in previous studies were mainly treated with intravenous fibrinolysis and also studied in the Caucasian populations. Objectives To compare the in-hospital mortality rate of patients with acute inferior wall ST elevation myocardial infarction with and without right ventricular infarction involvement, whom were treated with primary percutaneous coronary intervention (PPCI). Methods The study was a retrospective descriptive study which enrolled patients with acute inferior wall ST elevation myocardial infarction who were treated with PPCI in our hospital from 1 January 2007 - 31 December 2016. Results Among 452 acute inferior wall ST elevation myocardial infarction patients who were treated with PPCI, there were 99 patients who had right ventricular infarction involvement, the in-hospital mortality rate was 23.2%, mainly due to cardiogenic shock, compared with 5.1 % in patients who had no right ventricular infarction (p &lt; 0.001). Patients with right ventricular infarction had a significantly higher incidence of cardiogenic shock (48.5% versus 15.6%, P &lt; 0.001), the lower number of left ventricle ejection fraction (51.15 ± 17.27% versus 55.79 ± 12.46%, p = 0.037), the higher incidence of complete heart block (33.3% versus 11.9%, p &lt; 0.001) and ventricular tachycardia (15.2% versus 5.9%, p = 0.003). After adjustment for age, female sex, diabetes, hypertension, previous myocardial infarction, cardiogenic shock on admission, left ventricular ejection fraction, ventricular tachycardia and complete heart block, the right ventricular infarction remained the independent predictor of in-hospital death (adjusted hazard ratio, 1.69; 95% confidence interval, 0.38 to 7.48; P = 0.489) and significant independent predictor for 1-year mortality (adjusted hazard ratio, 2.76; 95% confidence interval, 1.08 to 7.03; P = 0.034). Conclusion Patients with acute inferior wall STEMI whom were treated with PPCI, if there was right ventricular infarction involvement, the in-hospital death and 1-year mortality were significantly higher than who were without right ventricular infarction.

Abstract 13861: Trends in Utilization of Mechanical Circulatory Assist Devices in Patients Presenting with ST Elevation Myocardial Infarction

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Shikhar Agarwal ◽  
Venu Menon
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
St Elevation Myocardial Infarction ◽  
Circulatory Support ◽  
Hierarchical Regression ◽  
Study Duration ◽  
Circulatory Assist Devices ◽  
St Elevation ◽  
Small Decline

Despite significant controversy about the efficacy, mechanical circulatory support (MCS) is often utilized in patients with cardiogenic shock after ST elevation myocardial infarction (STEMI). We aimed to characterize the trends and outcomes following the use of MCS devices in patients presenting with STEMI. Methods: We used the 2003-2011 US Nationwide Inpatient Sample for this study. All admissions with a principal diagnosis of STEMI were identified using standard ICD codes. MCS devices included intra aortic balloon pump or Impella and were identified using ICD procedure codes. Results: Of a total of 372984 admissions with STEMI, we identified 35685 (9.3%) cases that required MCS. Over the study duration, there was a significant increase in the utilization of MCS from 7.6% in 2003 to 10.5% in 2011 (Panel A). This increase in the use of MCS was accompanied by a significant increase in the incidence of cardiogenic shock in the study population (Panel A). Despite an increase in the overall cardiogenic shock incidence, there was a significant increase in the relative utilization of MCS in cardiogenic shock (Panel B) during the study duration. Of all the cardiogenic shock cases, utilization of MCS increased from 48.6% in 2003 to 57.4% in 2009, followed by a small decline to 54.7% in 2011. Among patients with cardiogenic shock, in-hospital mortality rate was 31.5% in patients with MCS as compared to 42.4% in those treated without MCS (p<0.001). Using multivariable hierarchical regression modeling, we found a significant reduction in adjusted in-hospital mortality with MCS, among patients with cardiogenic shock [OR (95% CI): 0.82 (0.77-0.88), p<0.001]. Conclusions: Over the last decade, there has been a significant increase in the utilization of MCS in patients with STEMI. In contrast to the results of the IABP trial, the use of MCS was associated with a significant reduction in in-hospital mortality in this real world nationwide experience.

scholarly journals Was the atrioventricular block similar in anterior and inferior ST-elevation myocardial infarction?

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
H Santos ◽  
M Santos ◽  
I Almeida ◽  
H Miranda ◽  
C Sa ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Atrioventricular Block ◽  
St Elevation Myocardial Infarction ◽  
Group A ◽  
St Elevation ◽  
Artery Disease ◽  
Group B ◽  
New Onset

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf Portuguese Registry of Acute Coronary Syndromes Background The presence of atrioventricular block (AVB) in ST-elevation myocardial infarction (STEMI) is more frequently registered when is identified in the inferior leads. However, AVB maybe occurs in anterior STEMI, yet the AVB and STEMI localization maybe had different implications. Objective Evaluate the impact and prognosis of AVB according to the STEMI localization. Methods Multicenter retrospective study, based on the Portuguese Registry of Acute Coronary Syndrome between 1/10/2010-3/05/2020. Patients were divided into two groups: A – patients with anterior STEMI, and B – patients with inferior STEMI. Were excluded patients without a previous cardiovascular history or clinical data regarding AVB occurrence. Logistic regression was performed to assess AVB as a prognostic marker in STEMI patients. Results From 32157 patients, was identified 462 with AVB, 72 in group A (15.6%) and 390 in group B (84.4%). Both groups were similar regarding gender (p = 0.710), age (p = 0.068), body mass index (p = 0.535), admitly directly to cat lab (p = 0.635), initial symptons until first medical contact (p = 0.561), smoker status (p = 0.483), diabetes mellitus (p = 0.331), coronary artery disease (p = 0.053), previous stroke (p = 0.332),  peripheral artery disease (p = 0.348), chronic kidney disease (p = 0.425), systolic blood pressure (p = 0.057), multivessel diasease (p = 0.235), new-onset of atrial fibrillation (p = 0.582), cardiac arrest (p = 0.062) and stroke complication (p = 0.685). Group B had higher left ventricular ejection fraction (LVEF) &gt;50% (16.9 vs 60.7%, p &lt; 0.001). On the other hand, group A had more arterial hypertension (79.7 vs 66.2%, p = 0.027), dislipidaemia (58.2 vs 54.4%, p = 0.038), heart rate at admission (81 ± 20 vs 59 ± 23, p &lt; 0.001), Killip-Kimball class &gt; I (45.7 vs 29.6%, p = 0.008), sinus rhythm at admission (84.5 vs 72.6%, p = 0.035), heart failure complication (65.3 vs 37.1%, p &lt; 0.001), cardiogenic shock complication (42.3 vs 24.7%, p &lt; 0.001), ACS mechanical complication (8.3 vs 3.1%, p = 0.047), sustained ventricular tachycardia during ACS hospitalization (19.4 vs 8.5%, p = 0.005) and hospitalization death (52.9 vs 44.7%, p &lt; 0.001). Logistic regression revealed that AVB in inferior STEMI was a predictor of new-onset of atrial fibrillation (odds ratio (OR) 3.817, p = 0.038, confidence interval (CI) 1.123-12.975), with a R2 Nagelkerke 24.4. Also, revealed that AVB in anterior STEMI was a predictor of death (OR 0.111, p &lt; 0.001, CI 0.034-0.366), with a R2 Nagelkerke 55.2. Conclusions AVB in inferior STEMI was a predictor of new-onset of atrial fibrillation and AVB in anterior STEMI was a predictor of death.

P2265Cardiogenic shock without severe left ventricular dysfunction after ST-elevation acute myocardial infarction: population characterization and impact in prognosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
B Picarra ◽  
J A Pais ◽  
A R Santos ◽  
M Carrington ◽  
D Bras ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Severe Left Ventricular Dysfunction ◽  
St Elevation ◽  
Group 1

Abstract Background The presence of cardiogenic shock (CS) after ST-elevation acute myocardial infarction (STEMI) is associated with a high mortality. Traditionally, severe left ventricular dysfunction is assumed to be the main predictor of CS, however trials and registries show that in average left ventricular function is only moderately depressed in CS after acute myocardial infarction. Purpose To characterize the population of patients (Pts) with CS after STEMI but without severe left ventricular dysfunction and assess their impact in mortality. Methods From a national multicenter registry, we evaluated 7181 Pts with STEMI and ejection fraction (EF) >30%, and excluded all pts with STEMI and an EF<30%. We considered 2 groups: Group 1 – Pts who developed CS and Group 2 - Pts who didn't developed CS. We registered age, gender, cardiovascular and non-cardiovascular co-morbidities, electrocardiographic presentation, vital signs at admission, reperfusion strategies, reperfusion times and coronary anatomy. We evaluated the following in-hospital complications: Re-Infarction, mechanical complications, high-grade atrial ventricular block, sustained ventricular tachycardia (VT) atrial fibrillation (AF) and stroke. We compared the in-hospital mortality. Results The presence of CS without severe left ventricular dysfunction was observed in 5,2% pts (n=376), being CS present at admission in 51,2% of these pts. The mean EF was lower in group 1 pts (44% ± 11 vs 51±11%, p<0,001). Patients in group 1 were older (70±14 vs 63±13 years, p<0,001), more females (39,4% vs 23,3%, p<0,001), had a higher prevalence of previous valvular heart disease (2,7% vs 1,0%, p=0,005), heart failure (4,8% vs 1,4%, p<0,001, peripheral artery disease (5,5% vs 2,9%, p=0,004), chronic kidney disease (6,4% vs 2,7%, p<0,001) and chronic pulmonary obstructive disease (8,2% vs 3,1%, p<0,001). At admission, Group 1 pts had more atrial fibrillation (10,4% vs 4,4%, p<0,001) and received less reperfusion (77,7% vs 83,0%, p=0,008), without differences in the type of reperfusion or times to reperfusion. The presence of multivessel disease (60,0% vs 45,7%, p<0,001) and left main disease (6,6% vs 2,4%, p<0,001) were more prevalent in Group 1 pts. Group 1 pts had more in-hospital complications: Re-Infarction (3,5% vs 0,7%, p<0,001), AF (22,1% vs 5,0%, p<0,001), mechanical complications (9,6% vs 0,5%, p<0,001), high atrial ventricular block (26,7% vs 3,7%, p<0,001), VT (10,6% vs 1,9%, p<0,001), stroke (1,9% vs 0,6%, p=0,01) and major bleeding (10,4% vs 1,5%, p<0,001). In-hospital mortality was much higher in Group 1 pts (26,6% vs 1,4%, p<0,001). Conclusions Cardiogenic shock is present in 5,2% of STEMI pts without severe ventricular dysfunction. These pts were older, more frequent female, had higher morbidities and in-hospital complications. Even without severe ventricular dysfunction, cardiogenic shock in these patients was associated with much higher in-hospital mortality.

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