Risk Factors Of In-hospital And Post-discharge Death In Patients With Acute ST-segment Elevation Myocardial Infarction After PrimaryPercutaneous Coronary Intervention

Aim To explore the risk factors of in-hospital and post-discharge death in patients with acute ST-segment elevation myocardial infarction after primary percutaneous coronary intervention.Methods 431 STEMI patients who underwent primary PCI were collected to investigate clinical data and follow-up results retrospectively. The follow-up endpoint was all-cause death after discharge. The in-hospital and post-discharge death were recorded to analyze related risk factors. SPSS 19.0 software was used to process the statistic data. The differences of in-hospital and post-discharge death were compared among patients with different clinical characteristics. The clinical characteristics which were significantly associated with the in-hospital and post-discharge death were corrected by logistic regression model or COX proportional hazard model.Results1、Risk factors of in-hospital death in patients with STEMI after primary PCI(1) A total of 431 STEMI patients were enrolled into the study, including 337 men (78.2%) and 94 women (21.8%). The average age was 64.5±12.2 years. The in-hospital mortality was higher in patients with female, age≥60 years, no smoking history, Killip class Ⅱ-Ⅳ level, LVEF<40%, extensive anterior STEMI, TIMI grade of IRA<3 flow after primary PCI, complicated with MVA, complicated with AF, the use of IABP and temporary pacemaker during the operation, no use of ACEI/ARB, no use of beta-blockers and no use of statins (P<0.05). The highest in-hospital mortality was 25.9%, which was in patients with TIMI grade of IRA<3 flow after primary PCI.(2) There were 18 patients died during the hospitalization and the in-hospital mortality was 4.2%.50% of the patients died of cardiogenic shock.(3) Logistic regression analysis showed that extensive anterior STEMI (OR=8.410, P=0.003), complicated with MVA (OR=14.658,P=0.001), TIMI grade of IRA 3 flow after primary PCI (OR=-2.109, P=0.013), the use of ACEI/ARB (OR=-1.995, P=0.019) and the use of beta-blockers (OR=-2.706, P=0.000) were associated with in-hospital death in STEMI patients after primary PCI.2、Risk factors of post-discharge death in patients with STEMI after primary PCI(1) A total of 413 STEMI patients were enrolled into the study, including 327 men (79.2%) and 86 women (20.8%). The average age was 64.0±12.1 years. The average follow-up time was 26.38±14.21 months.27 patients died and 43 patients lost to follow up (10.4%) during the follow-up period. The post-discharge mortality was higher in patients with female, age≥60 years, no smoking history, Killip class Ⅱ-Ⅳ level, LVEF<40%, extensive anterior STEMI, complicated with AF, the use of IABP and temporary pacemaker during the operation (P<0.05).The highest post-discharge mortality was 25.5%, which was in patients complicated with AF.(2) The cumulative mortalities of 30-day,6-month,1-year,2-year and 3-year in all follow-up patients were 1.9%,4.1%,4.9%,7.3% and 7.9% respectively.(3) COX regression analysis showed that age≥60 years (HR=9.337, P=0.030), Killip class Ⅱ-Ⅳ level (HR=4.116, P=0.000) and complicated with AF (HR=5.712, P= 0.000) were associated with post-discharge death in STEMI patients after primary PCI.Conclusions1、Cardiogenic shock is the leading cause of in-hospital death. Extensive anterior STEMI and complicated with MVA are independent risk factors of in-hospital death in STEMI patients after primary PCI. On the contrary, TIMI grade of IRA 3 flow after primary PCI and the use of ACEI/ARB and beta-blockers are independent protective factors.2、The post-discharge mortality is still high in patients with STEMI after primary PCI. Age≥60 years, Killip class Ⅱ-Ⅳ level and complicated with AF are independent risk factors of post-discharge death in STEMI patients after primary PCI.