The mid-term mortality and mode of death in survivors with st-elevation myocardial infarction

Naoki Yoshioka, Kensuke Takagi, Akihito Tanaka, Yasuhiro Morita, Ruka Yoshida, Yasunori Kanzaki, Hiroaki Nagai, Naoki Watanabe, Ryota Yamauchi, Shotaro Komeyama, Hiroki Sugiyama, Kazuki Shimojo, Takuro Imaoka, Gaku Sakamoto, Takuma Ohi, Hiroki Goto, Hideki Ishii, Itsuro Morishima, Toyoaki Murohara

Research output: Contribution to journalArticlepeer-review

Abstract

Objective The popularity of primary percutaneous coronary intervention (p-PCI) for ST-elevation myocardial infarction (STEMI) has increased over the past decades. Despite improvements in in-hospital mortality rates, it is clinically important to investigate the prognoses after discharge. However, data on the mode of death and prognostic factors are limited. We analyzed these factors in a Japanese cohort in the modern p-PCI era. Methods Between January 2004 and December 2017, a total of 1,222 patients who underwent p-PCI within 24 hours from the onset of STEMI and were alive at discharge (mean age, 67.7 years old; men, 75.5%), were evaluated. The two-year mortality was analyzed using a Cox regression model, and the mode of death was evaluated. Results The rate of mortality at 2 years was 5.7%. Non-cardiac death was more frequent than cardiac death (62.6% vs. 37.4%). A Cox multivariate analysis identified the following as independent predictors of the 2-year mortality: hemoglobin (log-transformed) [adjusted hazard ratio (HR), 0.048; 95% confidence interval (CI), 0.008-0.29; p<0.001], age above 80 years old (adjusted HR, 2.26; 95% CI, 1.30-3.91; p=0.004), Killip class !II (adjusted HR, 1.99; 95% CI, 1.17-3.39; p=0.011), brain natriuretic peptide level (log-transformed) (adjusted HR, 1.47; 95% CI, 1.09-2.01; p=0.013), and body mass index (log-transformed) (adjusted HR, 0.16; 95% CI, 0.030-0.84; p=0.030). Conclusion This study demonstrated that the 2-year mortality was 5.7% in STEMI survivors after p-PCI. Non-cardiac death was more frequent than cardiac death. Compared to well-known clinical variables, angiographic findings did not have a significant influence on the mid-term mortality.

Original languageEnglish
Pages (from-to)1665-1674
Number of pages10
JournalInternal Medicine
Volume60
Issue number11
DOIs
Publication statusPublished - 01-06-2021

All Science Journal Classification (ASJC) codes

  • Internal Medicine

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