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Chowdhury MRK, Stub D, Dinh D, Karim MN, Siddiquea BN, Billah B. Preoperative Variables of 30-Day Mortality in Adults Undergoing Percutaneous Coronary Intervention: A Systematic Review. Heart Lung Circ 2024; 33:951-961. [PMID: 38570260 DOI: 10.1016/j.hlc.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND AND AIM Risk adjustment following percutaneous coronary intervention (PCI) is vital for clinical quality registries, performance monitoring, and clinical decision-making. There remains significant variation in the accuracy and nature of risk adjustment models utilised in international PCI registries/databases. Therefore, the current systematic review aims to summarise preoperative variables associated with 30-day mortality among patients undergoing PCI, and the other methodologies used in risk adjustments. METHOD The MEDLINE, EMBASE, CINAHL, and Web of Science databases until October 2022 without any language restriction were systematically searched to identify preoperative independent variables related to 30-day mortality following PCI. Information was systematically summarised in a descriptive manner following the Checklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies checklist. The quality and risk of bias of all included articles were assessed using the Prediction Model Risk Of Bias Assessment Tool. Two independent investigators took part in screening and quality assessment. RESULTS The search yielded 2,941 studies, of which 42 articles were included in the final assessment. Logistic regression, Cox-proportional hazard model, and machine learning were utilised by 27 (64.3%), 14 (33.3%), and one (2.4%) article, respectively. A total of 74 independent preoperative variables were identified that were significantly associated with 30-day mortality following PCI. Variables that repeatedly used in various models were, but not limited to, age (n=36, 85.7%), renal disease (n=29, 69.0%), diabetes mellitus (n=17, 40.5%), cardiogenic shock (n=14, 33.3%), gender (n=14, 33.3%), ejection fraction (n=13, 30.9%), acute coronary syndrome (n=12, 28.6%), and heart failure (n=10, 23.8%). Nine (9; 21.4%) studies used missing values imputation, and 15 (35.7%) articles reported the model's performance (discrimination) with values ranging from 0.501 (95% confidence interval [CI] 0.472-0.530) to 0.928 (95% CI 0.900-0.956), and four studies (9.5%) validated the model on external/out-of-sample data. CONCLUSIONS Risk adjustment models need further improvement in their quality through the inclusion of a parsimonious set of clinically relevant variables, appropriately handling missing values and model validation, and utilising machine learning methods.
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Affiliation(s)
- Mohammad Rocky Khan Chowdhury
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Dion Stub
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia
| | - Diem Dinh
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Md Nazmul Karim
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Bodrun Naher Siddiquea
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia.
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Chow C, Doll J. Contemporary Risk Models for In-Hospital and 30-Day Mortality After Percutaneous Coronary Intervention. Curr Cardiol Rep 2024; 26:451-457. [PMID: 38592570 DOI: 10.1007/s11886-024-02047-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE OF REVIEW Risk models for mortality after percutaneous coronary intervention (PCI) are underutilized in clinical practice though they may be useful during informed consent, risk mitigation planning, and risk adjustment of hospital and operator outcomes. This review analyzed contemporary risk models for in-hospital and 30-day mortality after PCI. RECENT FINDINGS We reviewed eight contemporary risk models. Age, sex, hemodynamic status, acute coronary syndrome type, heart failure, and kidney disease were consistently found to be independent risk factors for mortality. These models provided good discrimination (C-statistic 0.85-0.95) for both pre-catheterization and comprehensive risk models that included anatomic variables. There are several excellent models for PCI mortality risk prediction. Choice of the model will depend on the use case and population, though the CathPCI model should be the default for in-hospital mortality risk prediction in the United States. Future interventions should focus on the integration of risk prediction into clinical care.
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Affiliation(s)
- Christine Chow
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jacob Doll
- Department of Medicine, University of Washington, Seattle, WA, USA.
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Gawinski L, Burzynska M, Marczak M, Kozlowski R. Assessment of In-Hospital Mortality and Its Risk Factors in Patients with Myocardial Infarction Considering the Logistical Aspects of the Treatment Process-A Single-Center, Retrospective, Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3603. [PMID: 36834296 PMCID: PMC9963836 DOI: 10.3390/ijerph20043603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Technological progress, such as the launching of a new generation of drug-coated stents as well as new antiplatelet drugs, has resulted in the treatment of myocardial infarction (MI) becoming much more effective. The aim of this study was to assess in-hospital mortality and to conduct an assessment of risk factors relevant to the in-hospital death of patients with MI. This study was based on an observational hospital registry of patients with MI (ACS GRU registry). For the purpose of the statistical analysis of the risk factors of death, a univariate logistic regression model was applied. In-hospital general mortality amounted to 7.27%. A higher death risk was confirmed in the following cases: (1) serious adverse events (SAEs) that occurred during the procedure; (2) patients transferred from another department of a hospital (OR = 2.647, p = 0.0056); (3) primary percutaneous coronary angioplasty performed on weekdays between 10 p.m. and 8 a.m. (OR = 2.540, p = 0.0146). The influence of workload and operator experience on the risk of death in a patient with MI has not been confirmed. The results of this study indicate the increasing importance of new risk factors for in-hospital death in patients with MI, such as selected logistical aspects of the MI treatment process and individual SAEs.
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Affiliation(s)
- Lukasz Gawinski
- Department of Management and Logistics in Health Care, Medical University of Lodz, 90-237 Lodz, Poland
| | - Monika Burzynska
- Department of Epidemiology and Biostatistics, Medical University of Lodz, 90-237 Lodz, Poland
| | - Michal Marczak
- Collegium of Management, WSB University in Warsaw, 03-204 Warsaw, Poland
| | - Remigiusz Kozlowski
- Center of Security Technologies in Logistics, Faculty of Management, University of Lodz, 90-237 Lodz, Poland
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Szabo D, Szabo A, Magyar L, Banhegyi G, Kugler S, Pinter A, Juhasz V, Ruppert M, Olah A, Ruzsa Z, Edes IF, Szekely A, Becker D, Merkely B, Hizoh I. Admission lactate level and the GRACE 2.0 score are independent and additive predictors of 30-day mortality of STEMI patients treated with primary PCI-Results of a real-world registry. PLoS One 2022; 17:e0277785. [PMID: 36383629 PMCID: PMC9668119 DOI: 10.1371/journal.pone.0277785] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In many of the risk estimation algorithms for patients with ST-elevation myocardial infarction (STEMI), heart rate and systolic blood pressure are key predictors. Yet, these parameters may also be altered by the applied medical treatment / circulatory support without concomitant improvement in microcirculation. Therefore, we aimed to investigate whether venous lactate level, a well-known marker of microcirculatory failure, may have an added prognostic value on top of the conventional variables of the "Global Registry of Acute Coronary Events" (GRACE) 2.0 model for predicting 30-day all-cause mortality of STEMI patients treated with primary percutaneous coronary intervention (PCI). METHODS In a prospective single-center registry study conducted from May 2020 through April 2021, we analyzed data of 323 cases. Venous blood gas analysis was performed in all patients at admission. Nested logistic regression models were built using the GRACE 2.0 score alone (base model) and with the addition of venous lactate level (expanded model) with 30-day all-cause mortality as primary outcome measure. Difference in model performance was analyzed by the likelihood ratio (LR) test and the integrated discrimination improvement (IDI). Independence of the predictors was evaluated by the variance inflation factor (VIF). Discrimination and calibration was characterized by the c-statistic and calibration intercept / slope, respectively. RESULTS Addition of lactate level to the GRACE 2.0 score improved the predictions of 30-day mortality significantly as assessed by both LR test (LR Chi-square = 8.7967, p = 0.0030) and IDI (IDI = 0.0685, p = 0.0402), suggesting that the expanded model may have better predictive ability than the GRACE 2.0 score. Furthermore, the VIF was 1.1203, indicating that the measured lactate values were independent of the calculated GRACE 2.0 scores. CONCLUSIONS Our results suggest that admission venous lactate level and the GRACE 2.0 score may be independent and additive predictors of 30-day all-cause mortality of STEMI patients treated with primary PCI.
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Affiliation(s)
- Dominika Szabo
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Andras Szabo
- School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Levente Magyar
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Szilvia Kugler
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Anita Pinter
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Vencel Juhasz
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Mihaly Ruppert
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Attila Olah
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zoltan Ruzsa
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Division of Invasive Cardiology, 2 Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | | | - Andrea Szekely
- Department of Oxiology and Emergency Care, Semmelweis University, Budapest, Hungary
| | - David Becker
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Istvan Hizoh
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- * E-mail:
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de Castro PPN, Castro MAN, Nascimento GA, Moura I, Pena JLB. Predictors of Hospital Mortality Based on Primary Angioplasty Treatment: A Multicenter Case-Control Study. Arq Bras Cardiol 2022; 119:448-457. [PMID: 35946752 PMCID: PMC9438550 DOI: 10.36660/abc.20210015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 09/24/2021] [Accepted: 01/19/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Identification of high-risk patients undergoing primary angioplasty (PCI) is essential. OBJECTIVE Identify factors related to the causes of death in PCI patients. METHODS This work consisted of a multicenter case-control study using a Brazilian registry of cardiovascular interventions as the data source. The association between each variable and death was assessed using a binary logistic regression model, p <0.05 was considered significant. RESULTS A total of 26,990 records were analyzed, of which 18,834 (69.8%) were male patients, with a median age of 61 (±17) years. In the multivariate analysis, the main variables related to the causes of death with their respective odds ratios and 95%confidence intervals (CI) were advanced age, 70-79 years (2.46; 1.64-3.79) and ≥ 80 years (3.69; 2.38-5.81), p<0.001; the classification of Killip II (2.71; 1.92-3.83), Killip III (8.14; 5.67-11.64), and Killip IV (19.83; 14.85-26.69), p<0.001; accentuated global dysfunction (3.63; 2,39-5.68), p<0.001; and the occurrence of infarction after intervention (5.01; 2.57-9.46), p<0.001. The main protective factor was the post-intervention thrombolysis in myocardial infarction (TIMI) III flow (0.18; 0.13-0.24), p<0.001, followed by TIMI II (0.59; 0.41 -0.86), p=0.005, and male (0.79; 0.64-0.98), p = 0.032; dyslipidemia (0.69; 0.59-0.85), p<0.001; and number of lesions treated (0.86; 0.9-0.94), p<0.001. CONCLUSION The predictors of mortality in patients undergoing PCI were Killip's classification, reinfarction, advanced age, severe left ventricular dysfunction, female gender, and post-intervention TIMI 0 / I flow.
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Affiliation(s)
- Pedro Paulo Neves de Castro
- Hospital Marcio CunhaIpatingaMGBrasilHospital Marcio Cunha – Hemodinâmica, Ipatinga, MG – Brasil
- Faculdade de Ciências Médicas de Minas GeraisPrograma de Pós-Graduação stricto sensu em Ciências da SaúdeBelo HorizonteMGBrasilFaculdade de Ciências Médicas de Minas Gerais – Programa de Pós-Graduação stricto sensu em Ciências da Saúde, Belo Horizonte, MG – Brasil
- Unimed Vale do AçoIpatingaMGBrasilUnimed Vale do Aço, Ipatinga, MG – Brasil
| | - Marco Antonio Nazaré Castro
- Hospital Marcio CunhaIpatingaMGBrasilHospital Marcio Cunha – Hemodinâmica, Ipatinga, MG – Brasil
- Unimed Vale do AçoIpatingaMGBrasilUnimed Vale do Aço, Ipatinga, MG – Brasil
| | - Guilherme Abreu Nascimento
- Hospital Marcio CunhaIpatingaMGBrasilHospital Marcio Cunha – Hemodinâmica, Ipatinga, MG – Brasil
- Unimed Vale do AçoIpatingaMGBrasilUnimed Vale do Aço, Ipatinga, MG – Brasil
| | - Isabel Moura
- Faculdade de Ciências Médicas de Minas GeraisPrograma de Pós-Graduação stricto sensu em Ciências da SaúdeBelo HorizonteMGBrasilFaculdade de Ciências Médicas de Minas Gerais – Programa de Pós-Graduação stricto sensu em Ciências da Saúde, Belo Horizonte, MG – Brasil
| | - José Luiz Barros Pena
- Faculdade de Ciências Médicas de Minas GeraisPrograma de Pós-Graduação stricto sensu em Ciências da SaúdeBelo HorizonteMGBrasilFaculdade de Ciências Médicas de Minas Gerais – Programa de Pós-Graduação stricto sensu em Ciências da Saúde, Belo Horizonte, MG – Brasil
- Hospital Felício RochoBelo HorizonteMGBrasilHospital Felício Rocho – Ecocardiografia, Belo Horizonte, MG – Brasil
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Nicolau JC. Infarto Agudo do Miocárdio com Supradesnivelamento do Segmento ST Tratado com Intervenção Coronária Percutânea Primária: A Importância de Dados Locais. Arq Bras Cardiol 2022; 119:458-459. [PMID: 36074377 PMCID: PMC9438528 DOI: 10.36660/abc.20220557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Song J, Liu Y, Wang W, Chen J, Yang J, Wen J, Gao J, Shao C, Tang YD. A nomogram predicting 30-day mortality in patients undergoing percutaneous coronary intervention. Front Cardiovasc Med 2022; 9:897020. [PMID: 36061568 PMCID: PMC9428350 DOI: 10.3389/fcvm.2022.897020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background and aims Early detection of mortality after percutaneous coronary intervention (PCI) is crucial, whereas most risk prediction models are based on outdated cohorts before the year 2000. This study aimed to establish a nomogram predicting 30-day mortality after PCI. Materials and methods In total, 10,444 patients undergoing PCI in National Center for Cardiovascular Diseases in China were enrolled to establish a nomogram to predict 30-day mortality after PCI. The nomogram was generated by incorporating parameters selected by logistic regression with the stepwise backward method. Results Five features were selected to build the nomogram, including age, male sex, cardiac dysfunction, STEMI, and TIMI 0–2 after PCI. The performance of the nomogram was evaluated, and the area under the curves (AUC) was 0.881 (95% CI: 0.8–0.961). Our nomogram exhibited better performance than a previous risk model (AUC = 0.7, 95% CI: 0.586–0.813) established by Brener et al. The survival curve successfully stratified the patients above and below the median score of 4. Conclusion A novel nomogram for predicting 30-day mortality was established in unselected patients undergoing PCI, which may help risk stratification in clinical practice.
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Affiliation(s)
- Jingjing Song
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yupeng Liu
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wenyao Wang
- Department of Cardiology, Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
- Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
| | - Jing Chen
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Yang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Wen
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Gao
- Department of Cardiology, Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
- Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
| | - Chunli Shao
- Department of Cardiology, Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
- Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
| | - Yi-Da Tang
- Department of Cardiology, Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
- Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
- *Correspondence: Yi-Da Tang,
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Hizoh I, Domokos D, Banhegyi G, Becker D, Merkely B, Ruzsa Z. Mortality prediction algorithms for patients undergoing primary percutaneous coronary intervention. J Thorac Dis 2020; 12:1706-1720. [PMID: 32395313 PMCID: PMC7212133 DOI: 10.21037/jtd.2019.12.83] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/16/2019] [Indexed: 11/06/2022]
Abstract
Mortality risk of ST-segment elevation myocardial infarction (STEMI) patients shows high variability. In order to assess individual risk, a number of scoring systems have been developed and validated. Yet, as treatment approaches evolve over time with improving outcomes, there is a need to build new risk prediction algorithms to maintain/increase prognostic accuracy. One of the most relevant improvements of therapy is primary percutaneous coronary intervention (PCI). We overview the characteristics and discriminative performance of the most studied and some recently constructed mortality risk models that were validated in patients with STEMI who underwent primary PCI.
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Affiliation(s)
- Istvan Hizoh
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Dominika Domokos
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - David Becker
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zoltan Ruzsa
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Invasive Cardiology, Bacs-Kiskun County University Teaching Hospital, Kecskemet, Hungary
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Cid Alvarez AB, Gomez-Peña F, Redondo-Dieguez A, Avila A, López D, Sanmartin X, González-Juanatey JR, Trillo-Nouche R. Prognostic impact of the SYNTAX score II in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: analysis of a four-year all-comers registry. EUROINTERVENTION 2019; 15:e796-e803. [PMID: 30175963 DOI: 10.4244/eij-d-18-00561] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS This study aimed to investigate the prognostic impact of the SYNTAX score II (SS-II) on ST-segment elevation myocardial infarction (STEMI) patients undergoing a primary percutaneous coronary intervention (pPCI). METHODS AND RESULTS This retrospective cohort study included 1,689 patients with STEMI who underwent pPCI between January 2008 and December 2016. The patients were categorised into three groups based on SS-II tertiles (SS-II low tertile <24 [n=585], SS-II intermediate tertile ≥24 and ≤34 [n=567], and SS-II high tertile >34 [n=537]). In-hospital mortality was significantly lower in patients with low and mid SS-II when compared with high SS-II (0.7% vs 0.5% vs 16.4%, p=0.001). During follow-up (median 2.35 years), a high SS-II was positively correlated with MACE (12.3% for low SS-II vs 18.3% for mid SS-II vs 43.2% for high SS-II, p=0.001), all-cause mortality (1.5% vs 3.9% vs 14.2%, p=0.001) and heart failure (0.3% vs 2.7% vs 8.2%, p=0.001). The SS-II showed additive value on top of GRACE, anatomical SYNTAX score and residual SYNTAX score. CONCLUSIONS The SS-II in patients with STEMI undergoing pPCI adds important prognostic information regarding midterm adverse outcomes, being an independent and powerful predictor of MACE, heart failure and all-cause mortality during follow-up.
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Affiliation(s)
- Ana Belen Cid Alvarez
- Cardiology Department, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
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Hizoh I, Banhegyi G, Domokos D, Gulyas Z, Major L, Kiss RG. Impact of Selective Aspiration Thrombectomy on Mortality in Patients With ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2018; 121:796-804. [PMID: 29397104 DOI: 10.1016/j.amjcard.2017.12.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/10/2017] [Accepted: 12/18/2017] [Indexed: 11/27/2022]
Abstract
Although routine aspiration thrombectomy (AT) is not recommended by the current American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions guideline, for selected cases, a class IIb indication is given because of lack of data. We studied the impact of selective AT on mortality in patients with ST-segment elevation myocardial infarction using a prospective registry. We analyzed data of 1,255 patients, of whom 535 underwent AT based on operator's decision. Separate propensity score matching procedures were performed including all patients and only those with initial TIMI (Thrombolysis In Myocardial Infarction) 0 to 1 flow, indicating the highest thrombus burden. Primary outcome measure was time to all-cause death at 1 year. Both studies were sufficiently powered to detect the hazard ratio (HR) of 0.52 seen in the TAPAS (Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study) trial. In the study with open inclusion criteria, 1-year mortality rates were 15.5% and 14.5% in the AT and conventional percutaneous coronary intervention arm, respectively (p = 0.77). The unadjusted HR was 1.05 (95% CI 0.73 to 1.51), p = 0.80, whereas the adjusted HR was 0.97 (95% CI 0.66 to 1.41), p = 0.87. In patients with initial TIMI 0 to 1 flow, mortality rate at 1 year was 15.6% in the AT and 16.7% in the standard percutaneous coronary intervention group (p = 0.76). The unadjusted and adjusted HRs were similar: 0.91 (95% CI 0.62 to 1.34), p = 0.65 and 0.93 (95% CI 0.62 to 1.37), p = 0.70, respectively. In conclusion, selective AT based on operator's discretion offers no mortality benefit of the magnitude detected in the TAPAS trial, even for patients with initial TIMI 0 to 1 flow grade.
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