Use of the Thrombolysis in Myocardial Infarction Risk Index for Elderly Patients With ST-Segment Elevation Myocardial Infarction

Background: Thrombolysis in Myocardial Infarction (TIMI) Risk Index (TRI) is a simple risk assessment tool for patients with ST-segment elevation myocardial infarction (STEMI). However, its applicability to elderly patients with STEMI undergoing percutaneous coronary intervention (PCI) is uncertain.Methods: This was a retrospective analysis of elderly (≥60 years) patients who underwent PCI for STEMI from January 2010 to April 2016. TRI was calculated on admission using the following formula: heart rate × (age/10)2/systolic blood pressure. Discrimination and calibration of TRI for in-hospital events and 1 year mortality were analyzed.Results: Totally 1,054 patients were divided into three groups according to the tertiles of the TRI: <27 (n = 348), 27–36 (n = 360) and >36 (n = 346). The incidence of acute kidney injury (AKI; 7.8 vs. 8.6 vs. 24.0%, p < 0.001), AHF (3.5 vs. 6.6 vs. 16.2%, p < 0.001), in-hospital death (0.6 vs. 3.3 vs. 11.6%, p < 0.001) and MACEs (5.2 vs. 5.8 vs. 15.9%, p < 0.001) was significantly higher in the third tertile. TRI showed good discrimination for in-hospital death [area under the curve (AUC) = 0.804, p < 0.001; Hosmer-Lemeshow p = 0.302], which was superior to its prediction for AKI (AUC = 0.678, p < 0.001; Hosmer-Lemeshow p = 0.121), and in-hospital MACEs (AUC = 0.669, p < 0.001; Hosmer-Lemeshow p = 0.077). Receiver-operation characteristics curve showed that TRI > 42.0 had a sensitivity of 64.8% and specificity of 82.2% for predicting in-hospital death. Kaplan-Meier analysis showed that patients with TRI > 42.0 had higher 1 year mortality (Log-rank = 79.2, p < 0.001).Conclusion: TRI is suitable for risk stratification in elderly patients with STEMI undergoing PCI, and is thus of continuing value for an aging population.

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The prognostic value of MELD-XI in elderly patients with ST-segment elevation myocardial infarction: an observational study

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-01862-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Song-jian He ◽

Jian-xin Weng ◽

Hai-jun Chen ◽

Hua-qiu Li ◽

Wen-qin Guo ◽

...

Keyword(s):

Myocardial Infarction ◽

Risk Assessment ◽

Elderly Patients ◽

Risk Score ◽

Prognostic Value ◽

Hospital Death ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Timi Risk Score

Abstract Background The model for end-stage liver disease excluding international normalized ratio (MELD-XI) is a simple score for risk assessment. However, the prognostic role of MELD-XI and its additional value to current risk assessment in elderly patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) is uncertain. Methods In all, 1029 elderly patients with STEMI undergoing PCI were consecutively included and classified into three groups according to the TIMI risk score: low-risk (≤ 3, n = 251); moderate-risk (4–6, n = 509); and high-risk (≥ 7, n = 269) groups. Multivariate analysis was performed to identify risk factors for adverse events. Results The overall in-hospital mortality was 5.3% and was significantly higher in the high-risk group (1.2% vs. 3.3% vs. 13.0%, p < 0.001). The optimal cut-off of the TIMI risk score and MELD-XI for in-hospital death was 7 and 13, respectively. MELD-XI was associated with in-hospital (adjusted odds ratio = 1.09, 95% CI = 1.04–1.14, p = 0.001) and one-year (adjusted hazard ratio = 1.05, 95% CI = 1.01–1.08, p = 0.005) mortality independently of the TIMI risk score. Combining TIMI risk score and MELD-XI exhibited better predictive power for in-hospital death than TIMI risk score (area under the curve [AUC] = 0.810 vs. 0.753, p = 0.008) or MELD-XI alone (AUC = 0.810 vs. 0.750, p = 0.018). Patients with TIMI risk score ≥ 7 and MELD-XI ≥ 13 had the worst prognosis. Conclusion MELD-XI could be considered as a risk-stratified tool for elderly patients with STEMI undergoing PCI. It had an additive prognostic value to TIMI risk score.

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Primary Coronary Intervention in Octogenarians and Nonagenarians With ST-Segment Elevation Myocardial Infarction: A Canadian Single-Center Perspective

Angiology ◽

10.1177/0003319717746520 ◽

2017 ◽

Vol 69 (8) ◽

pp. 718-723

Author(s):

Rajat Sharma ◽

Brett Hiebert ◽

David Cheung ◽

Davinder S. Jassal ◽

Kunal Minhas

Keyword(s):

Myocardial Infarction ◽

Elderly Patients ◽

Care Center ◽

Kidney Injury ◽

Coronary Intervention ◽

Control Group ◽

Very Elderly ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment

The proportion of individuals >80 years of age constitute an increasing proportion of patients who present with ST-segment elevation myocardial infarction (STEMI). The objective of this study is to evaluate in-hospital outcomes and 1-year survival of very elderly patients who present with an STEMI and undergo primary percutaneous coronary intervention (pPCI). Between 2009 and 2015, individuals >80 years of age (very elderly patients) with an STEMI presenting at a single tertiary Canadian care center were included in the study. A random sample of 100 individuals aged 65 to 69 years over the same time period were selected as a control group. A total of 284 patients were included in the study population including 100 controls, 164 octogenarians, and 20 nonagenarians. Of total, 1661 pPCIs occurred during this study period with the very elderly population (>80 years) comprising 11.1% of the total pPCIs. Compared with controls, individuals aged >80 are more likely to have a delay in treatment with increased rates of bleeding, acute kidney injury, rehospitalization, and a trend toward longer hospital stays following pPCI for STEMI. Although in-hospital and 1-year mortality were similar between both cohorts >80 years of age with STEMI, their overall survival was reduced compared with controls.

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Shock Index-C: An Updated and Simple Risk-Stratifying Tool in ST-Segment Elevation Myocardial Infarction

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.657817 ◽

2021 ◽

Vol 8 ◽

Author(s):

Peng Ran ◽

Xue-biao Wei ◽

Ying-wen Lin ◽

Guang Li ◽

Jie-leng Huang ◽

...

Keyword(s):

Myocardial Infarction ◽

Predictive Power ◽

Area Under The Curve ◽

Hospital Death ◽

Shock Index ◽

Roc Curve Analysis ◽

Chi Square ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment

Background: Shock index (heart rate/systolic blood pressure, SI) is a simple scale with prognostic value in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). The present study introduces an updated version of SI that includes renal function.Methods: A total of 1,851 consecutive patients with STEMI undergoing PCI were retrospectively included at Cardiac Care Unit in Guangdong Provincial People's Hospital and divided into two groups according to their admission time: derivation database (from January 2010 to December 2013, n = 1,145) and validation database (from January 2014 to April 2016, n = 706). Shock Index-C (SIC) was calculated as (SI × 100)–estimated CCr. Calibration was evaluated using the Hosmer-Lemeshow statistic. The predictive power of SIC was evaluated using receiver operating characteristic (ROC) curve analysis.Results: The predictive value and calibration of SIC for in-hospital death was excellent in derivation [area under the curve (AUC) = 0.877, p < 0.001; Hosmer-Lemeshow chi-square = 3.95, p = 0.861] and validation cohort (AUC = 0.868, p < 0.001; Hosmer-Lemeshow chi-square = 5.01, p = 0.756). SIC exhibited better predictive power for in-hospital events than SI (AUC: 0.874 vs. 0.759 for death; 0.837 vs. 0.651 for major adverse clinical events [MACEs]; 0.707 vs. 0.577 for contrast-induced acute kidney injury [CI-AKI]; and 0.732 vs. 0.590 for bleeding, all p < 0.001). Cumulative 1-year mortality was significantly higher in the upper SIC tertile (log-rank = 131.89, p < 0.001).Conclusion: SIC was an effective predictor of poor prognosis and may have potential as a novel and simple risk stratification tool for patients with STEMI undergoing PCI.

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Relation of Time to Coronary Reperfusion and the Development of Acute Kidney Injury After ST-Segment Elevation Myocardial Infarction

The American Journal of Cardiology ◽

10.1016/j.amjcard.2014.07.032 ◽

2014 ◽

Vol 114 (8) ◽

pp. 1131-1135 ◽

Cited By ~ 19

Author(s):

Yacov Shacham ◽

Eran Leshem-Rubinow ◽

Amir Gal-Oz ◽

Yaron Arbel ◽

Gad Keren ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Kidney Injury ◽

Kidney Injury ◽

Coronary Reperfusion ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment

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Comparison of epidemiology, treatments and outcomes of ST segment elevation myocardial infarction between young and elderly patients

Emergency Medicine Journal ◽

10.1136/emermed-2017-206754 ◽

2018 ◽

pp. emermed-2017-206754

Author(s):

Pin Pin Pek ◽

Huili Zheng ◽

Andrew Fu Wah Ho ◽

Win Wah ◽

Huay Cheem Tan ◽

...

Keyword(s):

Myocardial Infarction ◽

Elderly Patients ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment

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The effects of percutaneous coronary intervention on mortality in elderly patients with non-ST-segment elevation myocardial infarction undergoing coronary angiography

Scottish Medical Journal ◽

10.1177/0036933020919931 ◽

2020 ◽

Vol 65 (3) ◽

pp. 81-88

Author(s):

Pınar D Gündoğmuş ◽

Emrah B Ölçü ◽

Ahmet Öz ◽

İbrahim H Tanboğa ◽

Ahmet L Orhan

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Coronary Angiography ◽

Elderly Patients ◽

Coronary Intervention ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Percutaneous Coronary ◽

One Year

Introduction Although it is recommended that elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) should undergo an assessment for invasive revascularization, these patients undergo fewer coronary interventions despite the current guidelines. The aim of the study is to evaluate the effectiveness of percutaneous coronary intervention on all-cause mortalities monthly and annually in the population. Methods Three hundred and twenty-four patients with NSTEMI aged 65 years or older who underwent coronary angiography and treated with conservative strategy or percutaneous coronary intervention were included in the study. All demographic and clinical characteristics of the patients were recorded and one-month and one-year follow-up results were analysed. Results Two hundred eight cases (64.19%) were treated with percutaneous coronary intervention and 116 cases (35.81%) of the participant were treated with conservative methods. The mean age of the participants was 75.41 ± 6.65 years. The treatment strategy was an independent predictor for the mortality of one-year (HR: 1.965). Furthermore, Killip class ≥2 (HR:2.392), Left Ventricular Ejection Fraction (HR:2.637) and renal failure (HR: 3.471) were independent predictors for one-year mortality. Conclusion The present study has revealed that percutaneous coronary intervention was effective on one-year mortality in NSTEMI patients over the age of 65. It is considered that percutaneous coronary intervention would decrease mortality in these patients but it should be addressed in larger population studies.

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