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In-hospital mortality after acute STEMI in patients undergoing primary PCI

Krankenhausmortalität nach akutem STEMI bei Patienten mit primärer PCI

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Abstract

Background

Acute myocardial infarction (AMI) is the main cause of global and in-hospital mortality in patients with cardiovascular diseases. We aimed to examine the association between the coronary artery involved and the in-hospital mortality in patients who underwent primary percutaneous coronary intervention (pPCI) after ST segment elevation myocardial infarction (STEMI).

Methods

The in-hospital mortality of STEMI patients who underwent pPCI was assessed at the Department of Cardiology, Harzklinik Goslar, Germany, which has no access to immediate mechanical circulatory support (MCS), between 2013 and 2017.

Results

We enrolled 312 STEMI patients, with a mean age of 67.1 ± 13.4 years, of whom 211 (68%) were male. In-hospital mortality was documented in 31 patients (10%). In-hospital mortality was associated with pre-hospital cardiopulmonary resuscitation (CPR; n = 39/12.5%), older age, lower systolic blood pressure, Killip class > 1, triple-vessel disease (each p < 0.0001), female gender (p = 0.0158), and with the localization of the treated culprit lesion in the left main coronary artery (LMCA; p = 0.0083) and in the ramus circumflexus (RCX; p = 0.0141).

Conclusion

In this monocentric cohort, all-cause in-hospital mortality of STEMI patients after pPCI was significantly higher in those patients with culprit lesions in the LMCA and in the RCX, which may prove to be a substantial novel risk factor for STEMI-related mortality. Increasing age and female gender may be interdependent risk factors for mortality in this patient population. Furthermore, our data highlight the importance of the availability of MCS options in pPCI centers for patients after CPR.

Zusammenfassung

Hintergrund

Der akute Myokardinfarkt ist die hauptsächliche Ursache für die globale und die Krankenhausmortalität bei Patienten mit kardiovaskulären Erkrankungen. Ziel der vorliegenden Studie war es, die Assoziation zwischen den beteiligten Koronararterien und der Krankenhausmortalität bei Patienten mit akutem ST-Hebungs-Myokardinfarkt (STEMI) zu untersuchen, bei denen eine primäre perkutane Koronarintervention (pPCI) durchgeführt wurde.

Methoden

Die Krankenhausmortalität zwischen 2013 und 2017 wurde bei STEMI-Patienten mit Zustand nach pPCI an der kardiologischen Abteilung der Asklepios Harzklinik Goslar, die keine mechanischen Unterstützungssysteme (MCS) zur Verfügung hat, erfasst.

Ergebnisse

Es wurden n = 312 Patienten in die Studie eingeschlossen, mit einem mittleren Alter von 67,1 ± 13,4 Jahren, davon waren n = 211 (68 %) Männer. Krankenhausmortalität wurde bei n = 31 Patienten (10 %) dokumentiert. Die Krankenhausmortalität war mit den folgenden Faktoren assoziiert: präklinische kardiopulmonale Reanimation (CPR; n = 39; 12,5 %), steigendes Alter, niedriger systolischer Blutdruckwert, Killip-Klasse > 1, 3‑Gefäß-Erkrankungen (jeweils p < 0,0001), weibliches Geschlecht und Lokalisation der behandelten Zielläsion des linken Hauptstamms (LMCA; p = 0,0083) und des Ramus circumflexus (RCX; p = 0,0141).

Schlussfolgerungen

Die vorliegenden monozentrischen Daten zeigen, dass STEMI-Patienten mit Zielläsion im LMCA und im RCX eine erhöhte Krankenhausmortalität aufweisen. Dieses Ergebnis könnte einen neuen substanziellen Risikofaktor für die STEMI-bezogene Krankenhausmortalität darstellen. Zunehmendes Alter und weibliches Geschlecht könnten als voneinander abhängige Risikofaktoren für die Mortalität bei STEMI-Patienten interpretiert werden. Darüber hinaus deuten diese Daten auf die wichtige Rolle der Verfügbarkeit und Verwendung der MCS für reanimierte STEMI-Patienten in pPCI-Zentren hin.

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Abbreviations

AMI:

acute myocardial infarction

CAD:

coronary artery disease

CRP:

cardiopulmonary resuscitation

FITT-STEMI registry:

Feedback Intervention and Treatment Times in ST-Elevation Myocardial Infarction registry

LAD:

left anterior descending

LMCA:

left main coronary artery

MCS:

mechanical circulation support

pPCI:

primary percutaneous coronary intervention

RCA:

right coronary artery

RCX:

ramus circumflexus

STEMI:

ST segment elevation myocardial infarction

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Authors and Affiliations

  1. Department of Cardiology, heart catheterization laboratory, Asklepios Harzklinik Goslar, Kösliner Straße 12, 38642, Goslar, Germany

    M. Ali MD, S. A. Lange MD, T. Wittlinger MD & G. Lehnert

  2. Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin Luther University Halle, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany

    M. Ali MD, A. G. Rigopoulos MD & M. Noutsias MD

  3. Medical Clinic II (Cardiology/Angiology/ Intensive Care Medicine), University Heart Centre Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    S. A. Lange MD

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Correspondence to M. Ali MD.

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Conflict of interest

M. Ali is the local p.i. of the FITT-STEMI registry at the Department of Cardiology, Asklepios Harzklinik Goslar. M. Noutsias has received grants by the Deutsche Forschungsgemeinschaft (DFG) through the Sonderforschungsbereich Transregio 19 “Inflammatory Cardiomyopathy” (SFB TR19) (TP B2), and by the University Hospital Gießen and Marburg Foundation Grant “T cell functionality” (UKGM 10/2009). M. Noutsias has been consultant to the IKDT (Institute for Cardiac Diagnosis and Therapy GmbH, Berlin) 06/2004-06/2008, and has received honoraria for presentations and/or participated in advisory boards from AstraZeneca, Bayer, Fresenius, Miltenyi Biotech, Novartis, Pfizer and Zoll. S.A. Lange, T. Wittlinger, G. Lehnert, and A.G. Rigopoulos declare that they have no competing interests.

The clinical data of the patients, including the Killip class on admission, were computed within the framework of the FITT-STEMI (Feedback Intervention and Treatment Times in ST-Elevation Myocardial Infarction) project, which is conducted as a multicenter registry for the evaluation of major adverse cardiovascular events (MACE) in STEMI patients (http://www.fitt-stemi.com/). The study was approved by the local ethics committee, and all included patients signed informed consent.

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Ali, M., Lange, S.A., Wittlinger, T. et al. In-hospital mortality after acute STEMI in patients undergoing primary PCI. Herz 43, 741–745 (2018). https://doi.org/10.1007/s00059-017-4621-y

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