Coronary artery disease
Prediction of One-Year Mortality Among 30-Day Survivors After Primary Percutaneous Coronary Interventions

https://doi.org/10.1016/j.amjcard.2005.09.131Get rights and content

Little information exists on the features that influence risk factors for death at 1 year among 30-day survivors of ST-elevation myocardial infarction (STEMI) that is treated with primary percutaneous coronary intervention (PCI). Accordingly, we examined 3,280 patients with STEMI who were enrolled in Stent-PAMI and CADILLAC trials, were treated with primary PCI, and survived >30 days after STEMI. Death at 1 year occurred in 74 patients (2.3%) who survived >30 days after their index STEMI. Patients who died at 1 year were more likely to be older and women and have lower body weight and greater prevalence of previous stroke. Similarly, the sum of ST elevations, 3-vessel or left anterior coronary disease, and final Thrombolysis In Myocardial Infarction grade <3 flow was higher, whereas left ventricular ejection fraction was lower among patients who died versus those who survived. The multivariate logistic regression model identified age >70 years (odds ratio [OR] 3.3 95% confidence interval [CI] 1.9 to 5.7), weight <80 kg (OR 1.9, 95% CI 1.1 to 3.6), any tachyarrhythmia during index hospitalization (defined as ventricular or supraventricular tachycardia that required treatment) (OR 2.4, 95% CI 1.2 to 4.8), number of diseased coronary arteries (OR 1.5, 95% CI 1.1 to 2.1), and left ventricular ejection fraction (each 10% decrease, OR 1.5, 95% CI 1.2 to 1.8) as factors independently associated with risk of death at 1 year among 30-day survivors. In conclusion, our study provides a method for clinicians to advise patients who are treated with primary PCI and survive the acute phase of STEMI with regard to patients’ long-term prognosis, thus enhancing planning and setting up of realistic expectations.

Section snippets

Patient population

For the purpose of this analysis, we pooled clinical, demographic, angiographic, in-hospital clinical events, and outcome data of patients with ST-elevation myocardial infarction (STEMI) who underwent primary PCI and were enrolled in the Stent-PAMI and the CADILLAC trials (training set).1, 2 The rationale, methods, and results of these patient studies have been previously published.1, 2 Briefly, the Stent-PAMI trial evaluated the efficacy of stent versus conventional balloon angioplasty in

Univariate association of 1-year mortality among 30-day survivors

Of the 3,280 patients in PAMI and CADILLAC who survived >30 days after the initial hospitalization, 74 (2.3%) died at the end of 1 year. Thirty-three percent of these deaths occurred in the first 3 months. Table 1, Table 2, Table 3 present differences in baseline clinical characteristics, angiographic features, and in-hospital treatments and treatments between patients who died and those who survived. Univariate correlates significantly associated with death (p <0.05) at 1 year among 30-day

Discussion

Our study is the first to provide an insight into the factors that are associated with death at 1 year among patients who undergo primary PCI and survive >30 days. Although some of the information that was available at presentation maintained its predictive value for later death, other data that were available after admission during hospitalization provided additional prognostic information. The finding of older age and lower body weight as a predictor of 30-day to 1-year mortality is

References (10)

There are more references available in the full text version of this article.

Cited by (55)

  • Early Ventricular Tachycardia or Fibrillation in Patients With ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention and Impact on Mortality and Stent Thrombosis (from the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction Trial)

    2017, American Journal of Cardiology
    Citation Excerpt :

    In contrast, VAs occurring before revascularization are likely related to a large preexisting or actively evolving infarct allowing for initiation of ventricular tachyarrhythmias in the peri-infarct region. Interestingly, the lack of association of late VAs in HORIZONS-AMI is contrary to results from the Pexelizumab in Conjunction With Angioplasty in Acute Myocardial Infarction3 and Primary Angioplasty in Myocardial Infarction (PAMI)17 trials, likely because HORIZONS-AMI enrolled of a more stable patient cohort. The present report represents a post hoc analysis that was not prespecified in the HORIZONS-AMI protocol; however, the stringent enrollment and follow-up process during the trial ensured that errors related to lack of identification of VT/VF before the index procedure and accurate detection of short- and long-term events were minimized.

View all citing articles on Scopus
View full text