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Background
Coronary heart disease remains the leading cause of mortality [1]. Prevention of in-hospital death is a crucial step in improving prognosis of patients with ST elevation myocardial infarction (STEMI). We want to investigate the risk factors of in-hospital death.
Methods
Source of data
Totally 9668 patients with acute STEMI in Beijing Anzhen Hospital, Capital Medical University from January 2002 to August 2019.
Inclusion criteria: (1) patient hospitalized with STEMI; (2) age of more than 18 years.
We established the diagnosis of acute myocardial infarction (AMI) and STEMI base on fourth universal definition of myocardial infarction [2].
Exclusion criteria: none.
Evaluation and diagnosis of in-hospital death
All causes for in-hospital death is defined as cardiac or non-cardiac death during hospitalization.
Predictors
We selected 11 predictor variables for inclusion in our prediction rule. They were shown in Table 1. PCI = percutaneous coronary intervention, CABG = coronary artery bypass grafting. Atrial fibrillation is defined as all type of atrial fibrillation during hospitalization. Atrioventricular block is defined as all type of atrioventricular block during hospitalization.
Statistical analysis
We followed the methods of Li et al. 2019 [3].
Results
Participants and predictors of in-hospital death
Totally 188 patients had in-hospital death (in-hospital death group) and 9480 patients had no in-hospital death (control group). The results are shown in Table 1.
Predictors of in-hospital death
Eight variables (age, gender, history of myocardial infarction, history of hypertension, Killip classification, atrial fibrillation, atrioventricular block, and underwent PCI during hospitalization) were significant differences in the two groups of patients (p < 0.05). After application of backward variable selection method, three variables (underwent PCI, age, and Killip classification) remained as significant independent predictors of in-hospital death. Results are shown in Tables 2 and 3.
We drew the receiver operating characteristic curve. The area under the receiver operating characteristic curve was 0.94 ± 0.007, 95% CI = 0.926–0.954.
Study limitations
This is a single-center experience. Some patients were enrolled > 10 years ago, thus their treatment may not conform to current standards and techniques.
Discussion
We investigated the predisposing factors of in-hospital death. A frequency of in-hospital death was 1.9% (188/9668). Killip classification is an independent risk factor of in-hospital death. In our study, patients with Killip class IV were at 64.7 higher risk of in-hospital death than patients with Killip class I–III. Not underwent PCI is an independent risk factor of in-hospital death. Patients who do not get successful reperfusion are at higher risk of early complications and death [4]. Age is an independent risk factor of in-hospital death. Older patients have more comorbidities and are less likely to receive reperfusion therapy [5, 6]. Elderly patients are also at particular risk of bleeding [4].
Conclusions
Age, not underwent PCI during hospitalization, and Killip classification are independent risk factors for predicting in-hospital death in patients with acute STEMI.
References
Benjamin EJ, Muntner P, Alonso A et al (2019) Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation 139(10):e56–e528
Thygesen K, Alpert JS, Jaffe AS et al (2019) Fourth universal definition of myocardial infarction (2018). Eur Heart J 40(3):237–269
Li Y, Lyu S (2019) Risk factors of periprocedural bradycardia during primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction. Cardiol Res Pract 2019:4184702
Ibanez B, James S, Agewall S et al (2018) 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 39(2):119–177
Toleva O, Ibrahim Q, Brass N, Sookram S, Welsh R (2015) Treatment choices in elderly patients with ST: elevation myocardial infarction—insights from the Vital Heart Response registry. Open Heart 2(1):e000235
Malkin CJ, Prakash R, Chew DP (2012) The impact of increased age on outcome from a strategy of early invasive management and revascularisation in patients with acute coronary syndromes: retrospective analysis study from the ACACIA registry. BMJ Open 2(1):e000540
Funding
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Authors and Affiliations
Contributions
Yong Li contributed to generating the study data, analysed, interpreted the study data, drafted the manuscript, and revised the manuscript. Yong Li is responsible for the overall content as guarantor. All authors have read and approved the manuscript.
Corresponding author
Ethics declarations
Conflicts of interests
The authors declare that they have no competing interests.
Ethics approval and consent to participate
Ethic committee approved the study. Approved No. of ethic committee: 2019039X. Name of the ethic committee: Ethics committee of Beijing Anzhen Hospital Capital Medical University. It was a retrospective analysis and informed consent was waived by Ethics Committee of Beijing Anzhen Hospital Capital Medical University.
Statement of human and animal rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was not conducted with animals.
Informed consent
It was a retrospective analysis and informed consent was waived by Ethics Committee of Beijing Anzhen Hospital Capital Medical University.
Consent for publication
None.
Availability of data and material
The data used to support the findings of this study are included within the supplementary material.
Code availability (software application or custom code)
The data are demographic, clinical, and angiographic characteristics of patients with acute STEMI. DIE = in-hospital death; AGE = age; G = gender; HBP = history of hypertension; DM = history of diabetes; OMI = history of myocardial infarction; HPCI = history of percutaneous coronary intervention; CABG = history of coronary artery bypass grafting; HCD = history of cerebrovascular disease; CKD = history of chronic kidney disease; KI = Killip I; KII = Killip II; KIII = Killip III; KIV = Killip IV; AVB = atrioventricular block; ALLAF = atrial fibrillation; PCI = underwent PCI during hospitalization.
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We registered this study with WHO International Clinical Trials Registry Platform (ICTRP) (registration number: ChiCTR1900027129; registered date: 1 November 2019). https://www.chictr.org.cn/edit.aspx?pid=44888&htm=4
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Li, Y. Risk factors of in-hospital death in patients with acute ST elevation myocardial infarction. Intern Emerg Med 15, 1335–1337 (2020). https://doi.org/10.1007/s11739-020-02338-8
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DOI: https://doi.org/10.1007/s11739-020-02338-8