Primary coronary angioplasty in ST-elevation myocardial infarction: prediction of the thirty-day mortality risk in an unselected population of patients.
BACKGROUND
The 30-day mortality in catheter-based reperfusion therapy in patients with acute myocardial infarction varies widely in the literature and only some factors, such as cardiogenic shock, are clearly associated with the risk. This non-randomized, single center study investigates the potential factors influencing the 30-day mortality in 586 consecutive patients with ST-elevation myocardial infarction, treated with primary coronary angioplasty (PTCA).


METHODS
In the whole series and in two subgroups (with and without cardiogenic shock) the clinical, angiographic and procedural variables were used to develop multivariate statistical models for the prediction of the endpoint.


RESULTS
The overall 30-day mortality was 7.3%: 35.8 and 4.5% in patients with and without cardiogenic shock, respectively (p < 0.001). Independent predictors of the 30-day mortality included: a) in the entire series: shock, PTCA angiographic success, time to treatment, age, and coronary artery disease extension; b) in patients with cardiogenic shock: PTCA angiographic success, time to treatment, coronary artery disease extension, and use of abciximab; c) in patients without cardiogenic shock: time to treatment, age, and coronary artery disease extension.


CONCLUSIONS
In patients with ST-elevation myocardial infarction submitted to primary PTCA, the 30-day mortality rate is a highly predictable endpoint. The role of abciximab therapy and of other independent predictors varies according to the presence or otherwise of cardiogenic shock.
Interventional Cardiology Unit, Department of Cardiac Sciences, San Camillo-Forlanini Hospital, Rome, Italy. parma777@yahoo.it
Antonio
A
Parma
Rosario
R
Fiorilli
Marco Stefano
MS
Nazzaro
Maurizio
M
Menichelli
Edoardo
E
Pucci
Francesco
F
De Felice
Carla
C
Boschetti
Paolo
P
Salvini
Roberto
R
Violini
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D011237:Predictive Value of Tests; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome