Prediction of one-year mortality among 30-day survivors after primary percutaneous coronary interventions.

Little information exists on the features that influence risk factors for death at 1 year among 30-day survivors of ST-elevation myocardial infarction (STEMI) that is treated with primary percutaneous coronary intervention (PCI). Accordingly, we examined 3,280 patients with STEMI who were enrolled in Stent-PAMI and CADILLAC trials, were treated with primary PCI, and survived >30 days after STEMI. Death at 1 year occurred in 74 patients (2.3%) who survived >30 days after their index STEMI. Patients who died at 1 year were more likely to be older and women and have lower body weight and greater prevalence of previous stroke. Similarly, the sum of ST elevations, 3-vessel or left anterior coronary disease, and final Thrombolysis In Myocardial Infarction grade <3 flow was higher, whereas left ventricular ejection fraction was lower among patients who died versus those who survived. The multivariate logistic regression model identified age >70 years (odds ratio [OR] 3.3 95% confidence interval [CI] 1.9 to 5.7), weight <80 kg (OR 1.9, 95% CI 1.1 to 3.6), any tachyarrhythmia during index hospitalization (defined as ventricular or supraventricular tachycardia that required treatment) (OR 2.4, 95% CI 1.2 to 4.8), number of diseased coronary arteries (OR 1.5, 95% CI 1.1 to 2.1), and left ventricular ejection fraction (each 10% decrease, OR 1.5, 95% CI 1.2 to 1.8) as factors independently associated with risk of death at 1 year among 30-day survivors. In conclusion, our study provides a method for clinicians to advise patients who are treated with primary PCI and survive the acute phase of STEMI with regard to patients' long-term prognosis, thus enhancing planning and setting up of realistic expectations.

Duke Scholars

Author Rajendra H. Mehta Medicine, Cardiology