Improving In-Hospital Mortality in the Setting of an Increasing Risk Profile among Patients Undergoing Catheter-Based Reperfusion for an Acute Myocardial Infarction Without Cardiogenic Shock

Steven P. Marso, Manohar Gowda, James H. O'Keefe, Michael M. Coen, Ben D. McCallister, Lee V. Giorgi, Kenneth C. Huber, Steven B. Laster, Warren L. Johnson, Barry D. Ruthefford

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

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) 4.0-8.1], 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.

Original languageEnglish (US)
Pages (from-to)711-716
Number of pages6
JournalJournal of Invasive Cardiology
Volume15
Issue number12
StatePublished - Dec 2003

Fingerprint

Cardiogenic Shock
Hospital Mortality
Reperfusion
Catheters
Myocardial Infarction
Mortality
Confidence Intervals
Percutaneous Coronary Intervention
Myocardial Reperfusion
Creatinine
Demography
Incidence

Keywords

  • Acute myocardial infarction
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Improving In-Hospital Mortality in the Setting of an Increasing Risk Profile among Patients Undergoing Catheter-Based Reperfusion for an Acute Myocardial Infarction Without Cardiogenic Shock. / Marso, Steven P.; Gowda, Manohar; O'Keefe, James H.; Coen, Michael M.; McCallister, Ben D.; Giorgi, Lee V.; Huber, Kenneth C.; Laster, Steven B.; Johnson, Warren L.; Ruthefford, Barry D.

In: Journal of Invasive Cardiology, Vol. 15, No. 12, 12.2003, p. 711-716.

Research output: Contribution to journalArticle

Marso, SP, Gowda, M, O'Keefe, JH, Coen, MM, McCallister, BD, Giorgi, LV, Huber, KC, Laster, SB, Johnson, WL & Ruthefford, BD 2003, 'Improving In-Hospital Mortality in the Setting of an Increasing Risk Profile among Patients Undergoing Catheter-Based Reperfusion for an Acute Myocardial Infarction Without Cardiogenic Shock', Journal of Invasive Cardiology, vol. 15, no. 12, pp. 711-716.
Marso, Steven P. ; Gowda, Manohar ; O'Keefe, James H. ; Coen, Michael M. ; McCallister, Ben D. ; Giorgi, Lee V. ; Huber, Kenneth C. ; Laster, Steven B. ; Johnson, Warren L. ; Ruthefford, Barry D. / Improving In-Hospital Mortality in the Setting of an Increasing Risk Profile among Patients Undergoing Catheter-Based Reperfusion for an Acute Myocardial Infarction Without Cardiogenic Shock. In: Journal of Invasive Cardiology. 2003 ; Vol. 15, No. 12. pp. 711-716.
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abstract = "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) 4.0-8.1], 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.",
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AU - Gowda, Manohar

AU - O'Keefe, James H.

AU - Coen, Michael M.

AU - McCallister, Ben D.

AU - Giorgi, Lee V.

AU - Huber, Kenneth C.

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AU - Ruthefford, Barry D.

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KW - Percutaneous coronary intervention

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