title: Analysis of the Clinical Characteristics, Management, and Causes of Death in Patients with ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention from 2005 to 2014.
abstract: It is unknown whether there has been any change in the causes of death for acute ST-segment elevation myocardial infarction (STEMI) in the era of aggressive reperfusion. We analyzed the direct causes of in-hospital death in patients with STEMI treated with primary percutaneous coronary intervention (PCI) in a tertiary referral center over the past 10 years.We retrospectively analyzed 878 STEMI patients treated with primary PCI in our hospital between January 2005 and December 2014. There were no significant changes in the age and sex of patients, but the prevalence of hypertension and smoking decreased. STEMI severity increased with more patients in Killip classification > 2. The number of out-ofhospital cardiac arrest events also increased over the 10 years. Symptom onset-to-door time did not change in the 10year study period. The care quality was improved with shorter door-to-balloon time for primary PCI and increased use of dual antiplatelet therapy. The all-cause in-hospital mortality was 9.1%, which did not vary over the 10 years. Multivariable analysis showed that Killip classification > 2 was the most important determinant of death. Cardiogenic shock was the major cause of cardiovascular death. There was an increase in non-cardiovascular causes of death in the most recent 3 years, with infection being a major problem.Despite improvement in care quality for STEMI, the in-hospital mortality did not decrease in this tertiary referral center over these 10 years due to increased disease severity and non-cardiovascular causes of death.
authors: Department of Internal Medicine, Institute of Clinical Medicine and Biostatistics Consulting Center, National Cheng Kung University Hospital and College of Medicine.
authors: Po-Tseng
authors: PT
authors: Lee
authors: Ting-Hsing
authors: TH
authors: Chao
authors: Ya-Ling
authors: YL
authors: Huang
authors: Sheng-Hsiang
authors: SH
authors: Lin
authors: Wei-Ming
authors: WM
authors: Wang
authors: Wen-Huang
authors: WH
authors: Lee
authors: Chen-Wei
authors: CW
authors: Huang
authors: Cheng-Han
authors: CH
authors: Lee
authors: Ju-Yi
authors: JY
authors: Chen
authors: Chih-Chan
authors: CC
authors: Lin
authors: Ping-Yen
authors: PY
authors: Liu
authors: Shih-Hung
authors: SH
authors: Chan
authors: Yen-Wen
authors: YW
authors: Liu
authors: Wei-Chuan
authors: WC
authors: Tsai
authors: Li-Jen
authors: LJ
authors: Lin
authors: Liang-Miin
authors: LM
authors: Tsai
authors: Yi-Heng
authors: YH
authors: Li
mesh_terms: D000368:Aged; D002423:Cause of Death; D019468:Disease Management; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D013624:Taiwan; D062606:Tertiary Care Centers; D061665:Time-to-Treatment