Predictors of 30-day and 1-year mortality after primary percutaneous coronary intervention for ST-elevation myocardial infarction.
OBJECTIVE
Predictors of 30-day mortality may differ from predictors of mortality at 1 year among 30-day survivors of ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). We aimed to evaluate the predictors of 30-day and 1-year mortality in unselected patients with STEMI treated with PCI.


METHODS
Individual patient data from 4732 patients with STEMI, who were treated with primary PCI during an 11-year study period, were recorded prospectively. Patient characteristics, 30-day, and 1-year outcome were evaluated.


RESULTS
At 30-day follow-up, 219 patients (4.6%) died; and out of the 4513 30-day survivors, 109 patients (2.8%) died at 1 year. Patients who died were older, had a higher risk profile. Higher rates of Killip class greater than 2 on admission, multivessel disease, and, more often, lower left ventricular ejection fraction were observed in patients who died. Mortality rate was 7.6% at 30 days among the females when compared with 3.7 among the males, P value less than 0.001. Age and sex-adjusted multivariate analysis revealed that previous myocardial infarction, diabetes, Killip class greater than 2, post-PCI thrombolysis in myocardial infarction flow less than 3, and left ventricular ejection fraction less than 30% were strong predictors of both 30-day and 1-year mortality. However, multivessel disease, anterior myocardial infarct location and in-hospital reinfarction, ischemic time, and pre-PCI thrombolysis in myocardial infarction flow less than 3 were particularly strong predictors of 30-day mortality.


CONCLUSIONS
Despite the fact that most characteristics of 30-day and 1-year mortality among 30-day survivors are similar, we found that variables that affect mortality beyond the acute phase may not necessarily be the same as those that influence early mortality.
Rasoul
Saman
S
Isala Klinieken, Locatie Weezenlanden, Department of Cardiology, Zwolle, The Netherlands.
Ottervanger
Jan Paul
JP
de Boer
Menko-Jan
MJ
Dambrink
Jan-Henk E
JH
Hoorntje
Jan C A
JC
Marcel Gosselink
A T
AT
Zijlstra
Felix
F
Suryapranata
Harry
H
van 't Hof
Arnoud W J
AW
D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D003326:Coronary Circulation; D048909:Diabetes Complications / Q000401:mortality / Q000628:therapy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
D002317:Cardiovascular Agents