scholarly journals Factors Associated with In-hospital Mortality in Patients with Acute Coronary Syndrome

2015 ◽  
Vol 1 (2) ◽  
pp. 68-74 ◽  
Author(s):  
Andreea Barcan ◽  
Istvan Kovacs ◽  
Ciprian Blendea ◽  
Marius Orzan ◽  
Monica Chitu
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Culprit Lesion ◽  
Left Main ◽  
St Segment Elevation ◽  
Factors Associated ◽  
Coronary Syndrome ◽  
St Segment

Abstract Introduction: The recent development of large networks dedicated to ST-segment elevation myocardial infarction (STEMI) led to a significant increase in the number of primary percutaneous interventions (p-PCI) parallel with mortality reduction in Acute Coronary Syndrome (ACS). The number of non ST segment elevation myocardial infarction (NSTEMI) is increasing and the highest mortality rates are encountered in patients with cardiogenic shock and/or out of hospital cardiac arrest associated to ACS. The aim of this study was to identify the factors associated with a higher mortality rate in a global population with acute coronary syndromes presented in the emergency department of a county clinical hospital which serves as a regional center for a STEMI network. Material and method: This is a retrospective study including 684 patients with acute coronary syndrome admitted in the Clinic of Cardiology from the County Clinical Emergency Hospital Tîrgu Mureș in 2014. In all the cases, the factors that correlated with in hospital mortality were identified and analyzed. Results: The incidence of arterial hypertension was significantly higher in patients admitted with unstable angina (75.0%) and STEMI cases with less than 12 hours onset of symptomatology (68.1%), while impaired renal function correlated with the presence of NSTEMI (66.6%). The presence of a multivessel disease was significantly correlated with cardiogenic shock. The localisation of the culprit lesion in the left anterior descending artery (LAD) significantly correlated with the development of cardiogenic shock, LAD culprit lesions being present in 44.4% of CS cases as compared with 21.7% of noCS cases in STEMI patients. In NSTEMI patients, the localisation of the culprit lesion in the left main artery (LM) significantly correlated with the development of cardiogenic shock, culprit lesions in the left main being present in 47.0% of CS cases as compared with 28.5% of noCS cases in STEMI patients. Conclusion: Patients presenting with out-of-hospital resuscitated cardiac arrest due to Acute Myocardial Infarction associate higher in-hospital mortality rates. In-hospital mortality seems to be highly correlated with the female gender, STEMI myocardial infarction and the presence of multivascular lesions.

scholarly journals Cardiogenic shock in patients presenting with acute left main coronary artery occlusion

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Braga ◽  
J Calvao ◽  
J C Silva ◽  
A Campinas ◽  
A Alexandre ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Left Main Coronary Artery ◽  
Left Main ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Background and purpose Acute myocardial infarction (AMI) due to left main coronary artery (LMCA) occlusion is a rare event, often catastrophic. Limited data are available about management and outcomes of patients with acute LMCA occlusion, including those presenting with cardiogenic shock (CS) at hospital admission. This study sought to describe patients with AMI due unprotected LMCA occlusion presenting with CS and to evaluate their in-hospital outcomes and 1-year mortality. Methods In this retrospective 2-center study, we identified 7630 patients with ST-segment elevation myocardial infarction (STEMI) or hight risk non-ST segment elevation myocardial infarction who underwent to emergent coronary angiography between January 2008 and December 2020. Among this cohort, we analysed 94 patients who presented with unprotected LMCA occlusion (Thrombolysis In Myocardial Infarction – TIMI ≤2) and divided them in 2 groups according to presence of signs of cardiogenic shock at admission: CS and no-CS. Results Of 94 patients with AMI due LMCA occlusion, 52 patients presented with CS (53.3%). Mean age was 62.8±11.5 years in CS and 62.0±15.9 years in no-CS patients, p=0.766. In both groups, most patients were male. STEMI presentation was more frequent in CS group (80.4% vs. 52.4%, p=0.004). Severe systolic dysfunction of left ventricle was more frequent in CS patients (81.1% vs. 33.3%, p<0.001). Compared to no-CS patients, CS group shown more often TIMI=0 (67.3% vs. 26.2%, p<0.001), collateral coronary circulation Rentrop 0–1 (95.3% vs. 75.0%, p=0.008), and slow-reflow/no-reflow phenomena (30.6% vs 3.8%, p=0.019) in emergent coronary angiography. The need of invasive mechanical ventilation (68.9% vs. 21.4%, p<0.001), and haemodialysis (20.5% vs. 2.4%, p=0.010) were more prevalent in CS patients. Likewise, mechanical circulatory support (MCS) was more frequently used in patients presented with CS (52.9% vs. 26.2%, p=0.009). In subgroup analysis, MCS implantation was not a survival predictor in CS patients (Odds ratio: 3.9 [95% confidence interval: 0.4 to 36.3], p=0.229). Ultimately, in-hospital mortality (78.8% vs. 16.7%, p<0.001) was higher in CS patients. On the other hand, in hospital survivors, there was no significant differences in 1-year mortality (11.1% vs. 23.5%, p=0.42) between both groups. Conclusions Nearly half of patients with AMI due LMCA occlusion presented with CS signs at first medical evaluation. This subgroup of patients had higher in-hospital mortality compared to those without CS, despite MCS implantation. Whether the use of a specific MCS device or whether early use of MCS can change the outcome remains to be elucidated. CS patients who survive to index-hospitalization, had similar long-term outcomes compared to no-CS patients. Further studies are imperative in this population to refine initial medical treatment in order to improve their prognosis. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Assessment of morbidity and fatal outcomes of Acute Coronary Syndrome in Scotland

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Grant Wyper ◽  
Samantha Alvarez-Madrazo ◽  
Kim Kavanagh ◽  
Martin Denvir ◽  
Marion Bennie
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Secondary Care ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
Diagnostic Threshold ◽  
St Segment ◽  
One Year

ABSTRACTObjectivesThere have been a number of key changes in the clinical definition and diagnostic threshold of acute coronary syndromes in the last 10 years. We have characterised temporal and geographic changes in the incidence and outcomes following Acute Coronary Syndrome (ACS: Unstable Angina (UA), Non ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI)) between 2009 and 2013. Approach65,137 hospitals stays were identified involving ACS (ICD-10: I20.0, I21 and I22) relating to 55,369 individuals identified through secondary care primary diagnosis records during 2009-2013. All prior and subsequent secondary care diagnoses from 1981-2014 were sourced for these patients and records were deterministically matched on a pseudo patient identifier to obtain the cause and date of death for purposes of follow-up. An incident ACS case was defined as such if the patient had not suffered an ACS in the five years prior to the hospital admission and all co-morbidities were derived from hospital diagnostic codes accompanying the ACS codes. ResultsFor the entire cohort, patients with an incident ACS were predominantly male (61.5%) with mean age 68 (SD=13.7 years). Co-morbidities included: 65.5% Other Ischaemic Heart Disease; 5.2% Stroke; 7.5% Peripheral Artery Disease; 14.8% Atrial Fibrillation; 42.0% Hypertension; 18.0% Diabetes Mellitus and 8.4% Chronic Kidney Disease. The overall incidence of ACS in 2009 was 204/100,000 and fell by 8.1% to 188/100,000 in 2013. Subtypes of ACS comprised 9.4% UA, 50.9% NSTEMI, 29.0% STEMI and 10.8% MI unspecified in 2013. In-hospital mortality following an incident ACS was 9.7% (95% CI: 9.2-10.3%) in 2009 and varied from 7.9 to 19.0% across the NHS boards. In 2013, in-hospital mortality was 8.5% (95% CI: 7.9-9.0%) ranging from 4.5 to 10.5% across the NHS boards. One-year mortality following an incident ACS in 2009 was 18.6% (95% CI: 17.9-19.4%) falling to 16.8% (95% CI: 16.1-17.5%) in 2013. Stratified by NHS board, the one-year mortality rate in 2009 varied from 16.9 to 28.0% and in 2013 ranged from 11.9 to 20.0% across the NHS boards. ConclusionThese findings highlight the importance of a cohort based record linkage approach to routine healthcare datasets. While there appears to be changes in incidence of ACS and its subtypes and changes in mortality over time, these findings reflect significant changes in clinical practice with respect to definition and diagnosis. Cautious interpretation is needed combined with further research to fully understand the epidemiological implications of our findings.

scholarly journals Trends and in-hospital mortality of Acute Coronary Syndrome at Shahid Gangalal National Heart Centre, Kathmandu, Nepal during 2001-2012

2014 ◽  
Vol 3 (1) ◽  
pp. 23-26
Author(s):  
Chandra Mani Adhikari ◽  
Deewakar Sharma ◽  
Rabi Malla ◽  
Sujeeb Rajbhandari ◽  
Roshan Raut ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Unstable Angina ◽  
St Elevation Myocardial Infarction ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
National Heart ◽  
St Segment ◽  
St Elevation

Background and aims: Acute coronary syndrome (ACS), which comprises acute ST-segment elevation myocardial infarction, non-ST segment elevation myocardial infarction and unstable angina is a major health problem and represents a large number of hospitalizations annually worldwide. We aim to describe pattern of the ACS admission and in-hospital mortality at tertiary national heart centre of the country. Methods: A hospital database was used to analyze all 7424 patients admitted in coronary care unit of the centre for ACS from September 2001 till December 2012. We evaluated trend of ACS admission and in-hospital mortality. Results: Five thousand three hundred ninety one (72.6%) were male and two thousand thirty three (27.4%) were female. Patient of 21years to 98 years were admitted for ACS .Four thousand five hundred and ninety nine(61.9%) patient were admitted due to ST elevation myocardial infarction, whereas one thousand nine hundred and thirteen (25.8%) were admitted for Unstable angina and nine hundred twelve (12.3%) were admitted for Non ST elevation myocardial infarction. In-hospital mortality was 5.74% for acute coronary syndrome. There was significant difference in in-hospital mortality between ST elevation myocardial infarction (7.76%), Non ST segment elevation acute coronary syndrome (3.61%) and Unstable Angina (1.88%).There is a gradual increase in Primary Percutaneous Coronary intervention as a mode of reperfusion therapy whereas there is a decrease in the rate of thrombolysis. Conclusion: Our study provides us some important information about the trend and in-hospital mortality rate in national heart centre. Though it is a single centre study can provide us the insight of the ACS outcome. DOI: http://dx.doi.org/10.3126/jaim.v3i1.10698 Journal of Advances in Internal Medicine 2014;03(01):23-26

Electrocardiographic characteristics associated with in-hospital outcome in patients with left main acute coronary syndrome: For contriving a new risk stratification score

2016 ◽  
Vol 7 (3) ◽  
pp. 200-207 ◽  
Author(s):  
Takayuki Iida ◽  
Fumito Tanimura ◽  
Kyoko Takahashi ◽  
Hideki Nakamura ◽  
Satoshi Nakajima ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Qrs Complex ◽  
Left Main ◽  
Survival Group ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Lead Avr ◽  
Risk Stratification Score

Aim: The aim of this study was to evaluate electrocardiographic characteristics associated with in-hospital prognosis in patients with left main acute coronary syndrome. Methods and results: A total of 89 left main acute coronary syndrome subjects were selected from 3357 consecutive acute coronary syndrome patients (2.7%). Patients of this study were divided into two groups; those who survived and those who died. Patients’ characteristics and electrocardiogram on admission were then retrospectively analyzed between the two groups. In-hospital mortality was 28.1%. The prevalence and degree of ST-segment elevation at lead aVL were significantly higher in the deceased group than in the survival group ( p<0.001). However, those at lead aVR did not show significant differences between the two groups. Moreover, the width of the QRS-complex was significantly wider (lead V3; p<0.001), and the level of five minus the absolute value of five minus number of ST-segment elevation (5–|5–ST|; due to the highest in-hospital mortality (70%) in the five-lead ST-segment elevation group) was significantly larger in the deceased group than in the survival group ( p<0.001). The odds ratios that predicted in-hospital cardiac death were 1.03 for width of the QRS-complex at lead V3 (95% confidence interval (CI); 1.01–1.06; p=0.003), 1.74 for 5–|5–ST| (95% CI; 1.03–3.00; p=0.040), and 1.44 for ST-segment elevation at lead aVL (95% CI; 0.93–2.23; p=0.100). Conclusions: ST-segment elevation at lead aVL rather than aVR, width of the QRS-complex at lead V3 and number of ST-segment elevation were the prognostic predictors for in-hospital mortality in patients with left main acute coronary syndrome. Electrocardiographic characteristics should be assessed in addition to the established risk score in patients with left main acute coronary syndrome.

scholarly journals Characteristics of In-Hospital Mortality among Patients with Acute Coronary Syndrome: A Single-Center Study in West Java, Indonesia

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Dennis Bonang Tessy ◽  
Miftah Pramudyo ◽  
Charlotte Johanna Cool
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Class I ◽  
West Java ◽  
Killip Class ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Background: Acute Coronary Syndrome (ACS) is a severe manifestation of coronary artery disease, classified into unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). In-hospital mortality in patients with ACS remains high despite the advancement of therapy. This study aimed to evaluate the characteristics of in-hospital mortality among ACS patients in West Java, Indonesia.Methods: This descriptive cross-sectional study analyzed retrospective secondary data of ACS patients who died during hospitalization in the period of July 2018 to June 2019 that were recorded in the ACS registry.Results: A total of 17 patients died during hospitalization in the study period. The mean age was 64.1 years, predominantly female (n=10). The prevalent diagnoses were STEMI (n=11) and NSTEMI (n=6). Interestingly, no patients had died from UA. Hypertension was the most frequent risk factor (11 of 17). Mortality among Killip Class I, II, III, and IV were 7, 5, 1, and 4 patients, respectively. The number of patients who died after underwent Percutaneous Coronary Intervention (PCI) was lower (n=6) than those who did not undergo PCI or those without revascularization (n=11).Conclusions: The incidence of in-hospital mortality with acute coronary syndrome is high in females, STEMI diagnosis, Killip Class I, and no revascularization.

scholarly journals Analysis of risk factors for different subtypes of acute coronary syndrome

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110083
Author(s):  
Lei Zhang ◽  
Juledezi Hailati ◽  
Xiaoyun Ma ◽  
Jiangping Liu ◽  
Zhiqiang Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Brain Natriuretic Peptide ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Amino Terminal ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Aims To investigate the different risk factors among different subtypes of patients with acute coronary syndrome (ACS). Methods A total of 296 patients who had ACS were retrospectively enrolled. Blood and echocardiographic indices were assessed within 24 hours after admission. Differences in risk factors and Gensini scores of coronary lesions among three groups were analyzed. Results Univariate analysis of risk factors for ACS subtypes showed that age, and levels of fasting plasma glucose, amino-terminal pro-brain natriuretic peptide, and creatine kinase isoenzyme were significantly higher in patients with non-ST-segment elevation myocardial infarction (NSTEMI) than in those with unstable angina pectoris (UAP). Logistic multivariate regression analysis showed that amino-terminal pro-brain natriuretic peptide and the left ventricular ejection fraction (LVEF) were related to ACS subtypes. The left ventricular end-diastolic diameter was an independent risk factor for UAP and ST-segment elevation myocardial infarction (STEMI) subtypes. The severity of coronary stenosis was significantly higher in NSTEMI and STEMI than in UAP. Gensini scores in the STEMI group were positively correlated with D-dimer levels (r = 0.429) and negatively correlated with the LVEF (r = −0.602). Conclusion Different subtypes of ACS have different risk factors. Our findings may have important guiding significance for ACS subtype risk assessment and clinical treatment.

Clots Kill: Hematologic Pharmacology for ST-Segment Elevation Myocardial Infarction

2012 ◽  
Vol 32 (6) ◽  
pp. 35-41
Author(s):  
Stacy H. James
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Antiplatelet Agents ◽  
Thrombin Inhibitors ◽  
Fibrinolytic Agents ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Drugs that work on the hematologic system play an important role in helping to limit the morbidity and mortality that can be associated with an acute coronary syndrome. The pharmacology of the fibrinolytic agents, thrombin inhibitors, and antiplatelet agents is described. A case study of a woman having an ST-segment elevation myocardial infarction is reviewed to highlight the importance of drugs that work on the hematologic system.

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