Predictors of In-Hospital Mortality of ST-Segment Elevation Myocardial Infarction Patients Presenting Beyond First 12 Hours from Symptom Onset: A Two Year Retrospective Analysis National Cardiac Centre Harapan Kita (NCCHK)
Author : W. Firmanda, D. K. Firmansyah, Rizki1, Y. Hendarto, B. Widyantoro, D. Zamroni,I. Firdaus, D. A. Ju
Upload Date : 19-04-2018
Background: The 2017 European Society of Cardiology guidelines for the management of acute myocardial infarction in patients with ST-segment elevation (STEMI) have acknowledged primary PCI in unstable STEMI patient presenting beyond first 12 hours from symptom onset and between the first 12-48 hours for asymptomatic stable patient. Predictors of in-hospital mortality could help to encourage to proceed reperfusion therapy for this special population.1
Objective: To investigate the predictors of in-hospital mortality of STEMI patients presenting beyond first 12 hours from symptom onset (late-presenter STEMI).
Method: A cohort of 514 late-presenter STEMI patients from June 2015-2017 in NCCHK was analyzed retrospectively. Baseline clinical characteristics, laboratory result, and ECG patterns were correlated with in-hospital outcomes. Relative Risk (RR) of in-hospital mortality endpoint was calculated using chi-square study. Factors that may influence the outcome were identified using multiple logistic regression analysis.
Results: The mean age of late-presenter STEMI patients was 59 years, 83% of patient were male. Of a total 510 late-presenter STEMI patients, about 75% was admitted between 12-48 hours from symptom onset. Most of the patients treated conventionally, and overall in-hospital mortality was 13%. The mortality risk was significantly higher in patient with KILLIP class II-IV at admission (RR 14, p <0.001), had initial random blood glucose level > 200 mg/dL (RR 6.8, p <0.001), TIMI >6 groups (RR 4.9, p <0.001), RV infarction (RR 2.9, p <0.001), STEMI involved lateral area (RR 2.6, p <0.001), had initial conduction abnormality (RR 2.5, p = 0.001), LVEF < 40% (RR 2.2, p = 0.001), underwent PPCI (RR 2.1, p = <0.001), and diabetic patient (RR 1.6, p = 0.02).
After adjusting for all clinical variables, multivariate analysis showed that KILLIP class II-IV at admission (RR: 13.1; 95% CI: 5.5-31.2; p<0.001), initial random blood glucose level > 200 mg/dL (RR: 7.0; 95% CI: 3.5-13.9; p<0.001), RV infarction (RR: 4.3; 95% CI: 1.7-10.7; p = 0.001), LVEF < 40% (RR: 2.6; 95% CI: 1.3-5.1; p = 0.007) and STEMI involved lateral area (RR: 2.5; 95% CI: 1.1-5.4; p = 0.02) remained as independent predictors of in-hospital mortality for late-presenter STEMI.
Conclusion: KILLIP class II-IV at admission, initial random glucose level > 200 mg/dL, RV infarction, LVEF <40% and STEMI involved lateral area are independent predictors of in-hospital mortality for late-presenter STEMI. Clinicians should consider reperfusion therapy when these factors were found in late-presenter STEMI.
KEYWORDS : Late-presenter STEMI, In-Hospital Mortality, Predictors
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