Clinical characteristics and risk assessment of ST-segment elevation myocardial infarction patients of an Iranian referral center.
OBJECTIVE
Cardiovascular diseases (CVDs) are the main cause of morbidity and mortality all over the world. Acute myocardial infarction (AMI) is the leading cause of death and disability in the Iranian population. This prospective comprehensive study aimed to assess the clinical characteristics and in-hospital outcomes with possible correlations between them in patients with AMI.


METHODS
From December 2009 to January 2011, patients admitted with ST-segment elevation myocardial infarction were included in this study. Patients' demographic data, drug history, prehospital delay, door-to-needle or door-to-balloon interval (time to order), type of intervention, presence of arrhythmia, hemodynamic parameters, Framingham risk score, electrocardiogram findings and laboratory data were recorded. Also the length of patients' hospitalization and in-hospital outcome were documented. The correlations between patients' baseline clinical data and in-hospital outcomes were investigated.


RESULTS
During the study period, 167 patients with a median age (range) of 61 (29-92) years were enrolled in our study. Patients' prehospital delay had the median (range) of 3 (0.5-48) h. Eighty-eight (52.7%) patients received streptokinase, for whom the median (range) of door-to-needle time was 30 (6-330) min. The door-to-balloon median (range) time of 44 (26.4%) patients treated with primary percutaneous coronary intervention (PCI) was 30 (60-300) min. Thirty-five (20.9%) patients were not eligible for thrombolysis or PCI due to late arrival (delay of more than 12 h). There were significant relationships between older ages of patients and occurrence of arrhythmia (P = 0.027), hypertension (P = 0.009) and consuming cardiovascular (P = 0.002) agents. In a multivariate analysis, younger individuals [odds ratio (OR) 0.036, 95% confidence interval (CI) 0.003-0.069] and those reperfused with primary PCI (OR 0.44, 95% CI 0.39-0.47) had significantly shorter hospital stays (discharged within a week).


CONCLUSIONS
Our results provide emphasis on prevention of cardiovascular risk factors and further support to decrease patients' prehospital delay and accelerate in-hospital interventions for patients with AMI.
Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Hossein
H
Khalili
Azita Hajhossein
AH
Talasaz
Yaser
Y
Jenab
Mojtaba
M
Salarifar
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D015897:Comorbidity; D017023:Coronary Angiography; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006784:Hospitals, Teaching; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007492:Iran / Q000453:epidemiology; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D012017:Referral and Consultation; D018570:Risk Assessment; D012307:Risk Factors; D013300:Streptokinase / Q000008:administration & dosage; D015912:Thrombolytic Therapy; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
D015415:Biomarkers; D002317:Cardiovascular Agents; D005343:Fibrinolytic Agents; D013300:Streptokinase