Strategies to Lower In-Hospital Mortality in STEMI Patients with Primary PCI: Analysing Two Years Data from a High-Volume Interventional Centre
Objectives. We aimed to analyse data from our high-volume interventional centre (>1000 primary percutaneous coronary interventions (PCI) per year) searching for predictors of in-hospital mortality in acute myocardial infarction (MI) patients. Moreover, we looked for realistic strategies and inter...
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | Journal of Interventional Cardiology |
| Online Access: | http://dx.doi.org/10.1155/2019/3402081 |
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| author | Alexandru Burlacu Grigore Tinica Igor Nedelciuc Paul Simion Bogdan Artene Adrian Covic |
| author_facet | Alexandru Burlacu Grigore Tinica Igor Nedelciuc Paul Simion Bogdan Artene Adrian Covic |
| author_sort | Alexandru Burlacu |
| collection | DOAJ |
| description | Objectives. We aimed to analyse data from our high-volume interventional centre (>1000 primary percutaneous coronary interventions (PCI) per year) searching for predictors of in-hospital mortality in acute myocardial infarction (MI) patients. Moreover, we looked for realistic strategies and interventions for lowering in-hospital mortality under the “5 percent threshold.” Background. Although interventional and medical treatment options are constantly expanding, recent studies reported a residual in-hospital mortality ranging between 5 and 10 percent after primary PCI. Current data sustain that mortality after ST-elevation MI will soon reach a point when cannot be reduced any further. Methods. In this retrospective observational single-centre cohort study, we investigated two-year data from a primary PCI registry including 2035 consecutive patients. Uni- and multivariate analysis were performed to identify independent predictors for in-hospital mortality. Results. All variables correlated with mortality in univariate analysis were introduced in a stepwise multivariate linear regression model. Female gender, hypertension, depressed left ventricular ejection fraction, history of MI, multivessel disease, culprit left main stenosis, and cardiogenic shock proved to be independent predictors of in-hospital mortality. The model was validated for sensitivity and specificity using receiver operating characteristic curve. For our model, variables can predict in-hospital mortality with a specificity of 96.60% and a sensitivity of 84.68% (p<0.0001, AUC = 0.93, 95% CI 0.922–0.944). Conclusions. Our analysis identified a predictive model for in-hospital mortality. The majority of deaths were due to cardiogenic shock. We suggested that in order to lower mortality under 5 percent, focus should be on creating a cardiogenic shock system based on the US experience. A shock hub-centre, together with specific transfer algorithms, mobile interventional teams, ventricular assist devices, and surgical hybrid procedures seem to be the next step toward a better management of ST-elevation MI patients and subsequently lower death rates. |
| format | Article |
| id | doaj-art-f4fd2a2ff58649c1869425f73edcfe13 |
| institution | Kabale University |
| issn | 0896-4327 1540-8183 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Interventional Cardiology |
| spelling | doaj-art-f4fd2a2ff58649c1869425f73edcfe132025-02-03T06:42:26ZengWileyJournal of Interventional Cardiology0896-43271540-81832019-01-01201910.1155/2019/34020813402081Strategies to Lower In-Hospital Mortality in STEMI Patients with Primary PCI: Analysing Two Years Data from a High-Volume Interventional CentreAlexandru Burlacu0Grigore Tinica1Igor Nedelciuc2Paul Simion3Bogdan Artene4Adrian Covic5Head of Department of Interventional Cardiology—Cardiovascular Diseases Institute, “Grigore T. Popa” University of Medicine, Iasi, RomaniaDepartment of Cardiovascular Surgery—Cardiovascular Diseases Institute, “Grigore T. Popa” University of Medicine, Iasi, RomaniaDepartment of Interventional Cardiology—Cardiovascular Diseases Institute, Iasi, RomaniaDepartment of Interventional Cardiology—Cardiovascular Diseases Institute, Iasi, RomaniaDepartment of Interventional Cardiology—Cardiovascular Diseases Institute, Iasi, RomaniaNephrology Clinic, Dialysis and Renal Transplant Center—“C.I. Parhon” University Hospital, “Grigore T. Popa” University of Medicine, Iasi, RomaniaObjectives. We aimed to analyse data from our high-volume interventional centre (>1000 primary percutaneous coronary interventions (PCI) per year) searching for predictors of in-hospital mortality in acute myocardial infarction (MI) patients. Moreover, we looked for realistic strategies and interventions for lowering in-hospital mortality under the “5 percent threshold.” Background. Although interventional and medical treatment options are constantly expanding, recent studies reported a residual in-hospital mortality ranging between 5 and 10 percent after primary PCI. Current data sustain that mortality after ST-elevation MI will soon reach a point when cannot be reduced any further. Methods. In this retrospective observational single-centre cohort study, we investigated two-year data from a primary PCI registry including 2035 consecutive patients. Uni- and multivariate analysis were performed to identify independent predictors for in-hospital mortality. Results. All variables correlated with mortality in univariate analysis were introduced in a stepwise multivariate linear regression model. Female gender, hypertension, depressed left ventricular ejection fraction, history of MI, multivessel disease, culprit left main stenosis, and cardiogenic shock proved to be independent predictors of in-hospital mortality. The model was validated for sensitivity and specificity using receiver operating characteristic curve. For our model, variables can predict in-hospital mortality with a specificity of 96.60% and a sensitivity of 84.68% (p<0.0001, AUC = 0.93, 95% CI 0.922–0.944). Conclusions. Our analysis identified a predictive model for in-hospital mortality. The majority of deaths were due to cardiogenic shock. We suggested that in order to lower mortality under 5 percent, focus should be on creating a cardiogenic shock system based on the US experience. A shock hub-centre, together with specific transfer algorithms, mobile interventional teams, ventricular assist devices, and surgical hybrid procedures seem to be the next step toward a better management of ST-elevation MI patients and subsequently lower death rates.http://dx.doi.org/10.1155/2019/3402081 |
| spellingShingle | Alexandru Burlacu Grigore Tinica Igor Nedelciuc Paul Simion Bogdan Artene Adrian Covic Strategies to Lower In-Hospital Mortality in STEMI Patients with Primary PCI: Analysing Two Years Data from a High-Volume Interventional Centre Journal of Interventional Cardiology |
| title | Strategies to Lower In-Hospital Mortality in STEMI Patients with Primary PCI: Analysing Two Years Data from a High-Volume Interventional Centre |
| title_full | Strategies to Lower In-Hospital Mortality in STEMI Patients with Primary PCI: Analysing Two Years Data from a High-Volume Interventional Centre |
| title_fullStr | Strategies to Lower In-Hospital Mortality in STEMI Patients with Primary PCI: Analysing Two Years Data from a High-Volume Interventional Centre |
| title_full_unstemmed | Strategies to Lower In-Hospital Mortality in STEMI Patients with Primary PCI: Analysing Two Years Data from a High-Volume Interventional Centre |
| title_short | Strategies to Lower In-Hospital Mortality in STEMI Patients with Primary PCI: Analysing Two Years Data from a High-Volume Interventional Centre |
| title_sort | strategies to lower in hospital mortality in stemi patients with primary pci analysing two years data from a high volume interventional centre |
| url | http://dx.doi.org/10.1155/2019/3402081 |
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