Back to Search
Start Over
Reperfusion Therapy and Predictors of 30-Day Mortality after ST-Segment Elevation Myocardial Infarction in a University Medical Center in Western Iran.
- Source :
-
Archives of Iranian Medicine (AIM) . Nov2021, Vol. 24 Issue 11, p796-803. 8p. - Publication Year :
- 2021
-
Abstract
- Background: Considerable variability in survival rate after ST-segment elevation myocardial infarction (STEMI) is present and outcomes remain suboptimal, especially in low- and middle-income contraries. This study aimed to investigate predictors of 30-day mortality after STEMI, including reperfusion therapy, in a tertiary hospital in western Iran. Methods: In this registry-based cohort study (2016-2019), we investigated reperfusion therapies - primary percutaneous coronary intervention (PPCI), pharmaco-invasive (thrombolysis followed by angiography/percutaneous coronary intervention), and thrombolysis alone - used in Imam-Ali hospital, the only hospital with a PPCI capability in the Kermanshah Province. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs), using Cox proportional-hazard models, to investigate the potential predictors of 30-day mortality including reperfusion therapy, admission types (direct admission/referral from non-PPCI-capable hospitals), demographic variables, coronary risk factors, vital signs on admission, medical history, and laboratory tests. Results: Data of 2428 STEMI patients (mean age: 60.73; 22.9% female) were available. Reperfusion therapy was performed in 84% of patients (58% PPCI, 10% pharmaco-invasive, 16% thrombolysis alone). Only 17% of the referred patients had received thrombolysis at non-PPCI-capable hospitals. Among patients with thrombolysis, only 38.2% underwent coronary angiography/ percutaneous coronary intervention. The independent predictors of mortality were: no reperfusion therapy (HR: 2.01, 95% CI: 1.36-2.97), referral from non-PPCI-capable hospitals (1.73, 1.22-2.46), age (1.03, 1.01-1.04), glomerular filtration rate (0.97, 0.96-0.97), heart rate > 100 bpm (1.94, 1.22-3.08), and systolic blood pressure < 100 mm Hg (4.92, 3.43-7.04). Mortality was lower with the pharmaco-invasive approach, although statistically non-significant, than other reperfusion therapies. Conclusion: Reperfusion therapy, admission types, age, glomerular filtration rate, heart rate, and blood pressure were independently associated with 30-day mortality. Using a comprehensive STEMI network to increase reperfusion therapy, especially pharmaco- invasive therapy, is recommended. [ABSTRACT FROM AUTHOR]
- Subjects :
- *GLOMERULAR filtration rate
*BLOOD pressure
*MYOCARDIAL reperfusion
*ACADEMIC medical centers
*PERCUTANEOUS coronary intervention
*CONFIDENCE intervals
*ACQUISITION of data methodology
*AGE distribution
*TERTIARY care
*PATIENTS
*RISK assessment
*CORONARY angiography
*HOSPITAL admission & discharge
*DESCRIPTIVE statistics
*HEART beat
*MEDICAL records
*DATA analysis software
*LONGITUDINAL method
*PROPORTIONAL hazards models
MYOCARDIAL infarction-related mortality
Subjects
Details
- Language :
- English
- ISSN :
- 10292977
- Volume :
- 24
- Issue :
- 11
- Database :
- Academic Search Index
- Journal :
- Archives of Iranian Medicine (AIM)
- Publication Type :
- Academic Journal
- Accession number :
- 154105484
- Full Text :
- https://doi.org/10.34172/aim.2021.119