Improving In-hospital Mortality in the Setting of an Increasing
Improving In-hospital Mortality in the Setting of an Increasing
Prompt myocardial reperfusion is the therapeutic goal for patients presenting with acute myocardial infarction (AMI). However, there remains a paucity of clinical data from single centers solely dedicated to a catheter-based reperfusion strategy. Therefore, we sought to identify significant predictors of in-hospital mortality, to determine the changing profile of patient demographics and to identify the mortality trend over time.
Methods: Consecutive patients who underwent percutaneous coronary intervention (PCI) for an AMI between January of 1982 and December of 1999 were included in this multivariable analysis (excluding cardiogenic shock). AMI was defined as an evolving myocardial infarction within the preceding 24 hours. The primary endpoint for this analysis was in-hospital mortality.
Results: There were 2,745 patients identified in this study, of which 8.3% (n = 228) were non-survivors. The significant multivariable predictors of in-hospital mortality included creatinine > 1.5 mg/dl [relative risk (RR), 5.7; 95% confidence interval (CI) 4.0-.1], ejection fraction < 40% (RR, 6.6; 95% CI, 4.3-10.0), multivessel disease (RR, 2.8; 95% CI, 1.9-4.2), female (RR, 2.3; 95% CI, 1.6-3.1) and age > 70 years (RR, 1.6; 95% CI, 1.1-2.2). The incidence of patients with these high-risk characteristics increased in recent years; thus, the unadjusted slope of the mortality trend over 20 years was not significant. However, following adjustment for the temporal shift in high-risk variables, there was a significant reduction in the adjusted in-hospital mortality rate (RR, 0.89; 95% CI 0.8-0.98; p = 0.017). Despite the changing risk profile, the short-term mortality continues to improve for patients undergoing AMI PCI.
Prompt myocardial reperfusion is the therapeutic goal for patients presenting with ST-segment elevation acute myocardial infarction (AMI). Numerous studies have now demonstrated the efficacy of a catheter-based reperfusion strategy among patients with AMI. This was first demonstrated in randomized controlled trials in the balloon angioplasty era and has recently been extended to the stent era. The preponderance of data come from the results of moderately sized, randomized, controlled trials from multiple institutions. There remains a paucity of data from a single center, solely dedicated to catheter-based reperfusion for patients presenting with an AMI. Therefore, we performed an analysis involving consecutive patients who presented to the Mid America Heart Institute (MAHI) with an AMI. The main objective of this study was to identify significant predictors of in-hospital mortality, to determine whether patient demographics have been changing over time and to determine if there has been a reduction in in-hospital mortality among patients referred for catheter-based reperfusion in the setting of AMI.
Prompt myocardial reperfusion is the therapeutic goal for patients presenting with acute myocardial infarction (AMI). However, there remains a paucity of clinical data from single centers solely dedicated to a catheter-based reperfusion strategy. Therefore, we sought to identify significant predictors of in-hospital mortality, to determine the changing profile of patient demographics and to identify the mortality trend over time.
Methods: Consecutive patients who underwent percutaneous coronary intervention (PCI) for an AMI between January of 1982 and December of 1999 were included in this multivariable analysis (excluding cardiogenic shock). AMI was defined as an evolving myocardial infarction within the preceding 24 hours. The primary endpoint for this analysis was in-hospital mortality.
Results: There were 2,745 patients identified in this study, of which 8.3% (n = 228) were non-survivors. The significant multivariable predictors of in-hospital mortality included creatinine > 1.5 mg/dl [relative risk (RR), 5.7; 95% confidence interval (CI) 4.0-.1], ejection fraction < 40% (RR, 6.6; 95% CI, 4.3-10.0), multivessel disease (RR, 2.8; 95% CI, 1.9-4.2), female (RR, 2.3; 95% CI, 1.6-3.1) and age > 70 years (RR, 1.6; 95% CI, 1.1-2.2). The incidence of patients with these high-risk characteristics increased in recent years; thus, the unadjusted slope of the mortality trend over 20 years was not significant. However, following adjustment for the temporal shift in high-risk variables, there was a significant reduction in the adjusted in-hospital mortality rate (RR, 0.89; 95% CI 0.8-0.98; p = 0.017). Despite the changing risk profile, the short-term mortality continues to improve for patients undergoing AMI PCI.
Prompt myocardial reperfusion is the therapeutic goal for patients presenting with ST-segment elevation acute myocardial infarction (AMI). Numerous studies have now demonstrated the efficacy of a catheter-based reperfusion strategy among patients with AMI. This was first demonstrated in randomized controlled trials in the balloon angioplasty era and has recently been extended to the stent era. The preponderance of data come from the results of moderately sized, randomized, controlled trials from multiple institutions. There remains a paucity of data from a single center, solely dedicated to catheter-based reperfusion for patients presenting with an AMI. Therefore, we performed an analysis involving consecutive patients who presented to the Mid America Heart Institute (MAHI) with an AMI. The main objective of this study was to identify significant predictors of in-hospital mortality, to determine whether patient demographics have been changing over time and to determine if there has been a reduction in in-hospital mortality among patients referred for catheter-based reperfusion in the setting of AMI.
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