title: Risk is not flat. Comprehensive approach to multidimensional risk management in ST-elevation myocardial infarction treated with primary angioplasty (ANIN STEMI Registry).
abstract: BACKGROUND
  Current risk assessment concepts in ST-elevation myocardial infarction (STEMI) are suboptimal for guiding clinical management.
  
  
  OBJECTIVE
  To elaborate a composite risk management concept for STEMI, enhancing clinical decision making.
  
  
  METHODS
  1995 unselected, registry patients with STEMI treated with primary percutaneous coronary intervention (pPCI) (mean age 60.1 years, 72.1% men) were included in the study. The independent risk markers were grouped by means of factor analysis, and the appropriate hazards were identified.
  
  
  RESULTS
  In-hospital death was the primary outcome, observed in 95 (4.7%) patients. Independent predictors of mortality included age, leukocytosis, hyperglycemia, tachycardia, low blood pressure, impaired renal function, Killip > 1, anemia, and history of coronary disease. The factor analysis identified two significant clusters of risk markers: 1. age-anemia- impaired renal function, interpreted as the patient-related hazard; and 2. tachycardia-Killip > 1-hyperglycemia-leukocytosis, interpreted as the event-related (hemodynamic) hazard. The hazard levels (from low to high) were defined based on the number of respective risk markers. Patient-related hazard determined outcomes most significantly within the low hemodynamic hazard group.
  
  
  CONCLUSIONS
  The dissection of the global risk into the combination of patient- and event-related (hemodynamic) hazards allows comprehensive assessment and management of several, often contradictory sources of risk in STEMI. The cohort of high-risk STEMI patients despite hemodynamically trivial infarction face the most suboptimal outcomes under the current invasive management strategy.
authors.affiliation: Coronary Disease and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland.
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kruk
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Jakub
authors.initials: J
authors.lastname: Przyłuski
authors.affiliation: Coronary Disease and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland.
authors.forename: Lukasz
authors.initials: L
authors.lastname: Kalińczuk
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Pręgowski
authors.affiliation: Coronary Disease and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland.
authors.forename: Edyta
authors.initials: E
authors.lastname: Kaczmarska
authors.affiliation: Coronary Disease and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Petryka
authors.affiliation: Coronary Disease and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland.
authors.forename: Cezary
authors.initials: C
authors.lastname: Kępka
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Bekta
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Chmielak
authors.affiliation: Coronary Disease and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Demkow
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Ciszewski
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Karcz
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kłopotowski
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Witkowski
authors.affiliation: Coronary Disease and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland.
authors.forename: Witold
authors.initials: W
authors.lastname: Rużyłło
keywords: ST-elevation acute coronary syndrome; acute coronary syndrome; primary angioplasty; risk assessment