Predictors of in-hospital mortality in patients with ST-segment elevation myocardial infarction undergoing pharmacoinvasive treatment.
OBJECTIVE
To identify predictors of in-hospital mortality in patients with acute myocardial infarction undergoing pharmacoinvasive treatment.


METHODS
This was an observational, prospective study that included 398 patients admitted to a tertiary center for percutaneous coronary intervention within 3 to 24 hours after thrombolysis with tenecteplase. ClinicalTrials.gov: NCT01791764 RESULTS: The overall in-hospital mortality rate was 5.8%. Compared with patients who survived, patients who died were more likely to be older, have higher rates of diabetes and chronic renal failure, have a lower left ventricular ejection fraction, and demonstrate more evidence of heart failure (Killip class III or IV). Patients who died had significantly lower rates of successful thrombolysis (39% vs. 68%; p = 0.005) and final myocardial blush grade 3 (13.0% vs. 61.9%; p<0.0001). Based on the multivariate analysis, the Global Registry of Acute Coronary Events score (odds ratio 1.05, 95% confidence interval (CI) 1.02-1.09; p = 0.001), left ventricular ejection fraction (odds ratio 0.9, 95% CI 0.89-0.97; p = 0.001), and final myocardial blush grade of 0-2 (odds ratio 8.85, 95% CI 1.34-58.57; p = 0.02) were independent predictors of mortality.


CONCLUSIONS
In this prospective study that evaluated patients with ST-segment elevation myocardial infarction treated by a pharmacoinvasive strategy, the in-hospital mortality rate was 5.8%. The Global Registry of Acute Coronary Events score, left ventricular ejection fraction, and myocardial blush were independent predictors of mortality in this high-risk group of acute coronary syndrome patients.
Department of Cardiology, Universidade Federal de São Paulo, São PauloSP, Brazil.
Felipe José de Andrade
FJ
Falcão
Department of Cardiology, Universidade Federal de São Paulo, São PauloSP, Brazil.
Cláudia Maria Rodrigues
CM
Alves
Department of Cardiology, Universidade Federal de São Paulo, São PauloSP, Brazil.
Adriano Henrique Pereira
AH
Barbosa
Department of Cardiology, Universidade Federal de São Paulo, São PauloSP, Brazil.
Adriano
A
Caixeta
Department of Cardiology, Universidade Federal de São Paulo, São PauloSP, Brazil.
José Marconi Almeida
JM
Sousa
Department of Cardiology, Universidade Federal de São Paulo, São PauloSP, Brazil.
José Augusto Marcondes
JA
Souza
Secretaria de Saúde do Município de São Paulo, São PauloSP, Brazil.
Amaury
A
Amaral
Secretaria de Saúde do Município de São Paulo, São PauloSP, Brazil.
Luiz Carlos
LC
Wilke
Hospital Municipal Tatuapé, São PauloSP, Brazil.
Fátima Cristina A
FC
Perez
Department of Cardiology, Universidade Federal de São Paulo, São PauloSP, Brazil.
Iran
I
Gonçalves Júnior
Department of Cardiology, Universidade Federal de São Paulo, São PauloSP, Brazil.
Edson
E
Stefanini
Department of Cardiology, Universidade Federal de São Paulo, São PauloSP, Brazil.
Antônio Carlos
AC
Carvalho
D000368:Aged; D001938:Brazil; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D000077785:Tenecteplase; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D015912:Thrombolytic Therapy / Q000379:methods; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D000077785:Tenecteplase