Sasaki Osamu, Nishioka Toshihiko, Inoue Yoshiro, Isshiki Ami, Sasaki Hideki
Cardiology, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN.
Internal Medicine, Mombetsu General Hospital, Mombetsu, JPN.
Cureus. 2023 Aug 12;15(8):e43392. doi: 10.7759/cureus.43392. eCollection 2023 Aug.
Factors such as age, vital signs, renal function, Killip class, cardiac arrest, elevated cardiac biomarker levels, and ST deviation predict survival in patients with acute myocardial infarction (AMI). However, the existing risk assessment tools lack comprehensive consideration of catheter-related factors, and short-term prognostic predictors are unknown. This study aimed to clarify in-hospital prognostic predictors in hospitalized patients with AMI.
Five hundred and thirty-six patients who underwent percutaneous coronary intervention (PCI) for AMI were divided into non-survivor (n = 36) and survivor (n = 500) groups. Coronary risk factors, laboratory findings, angiographic findings, and clinical courses were compared between the two groups. Multiple logistic regression was used to analyze in-hospital death in pre- and post-PCI phases.
In the pre-PCI phase, multiple logistic regression analysis revealed several predictors of in-hospital death, including systolic blood pressure [odds ratio (OR) = 0.985, p = 0.023)], Killip class ≥2 (OR = 14.051, p <0.001), and chronic kidney disease (OR = 4.859, p = 0.040). In the post-PCI phase, multiple logistic regression analysis revealed additional predictors of in-hospital death, including Killip class ≥2 (OR = 5.982, p = 0.039), presence of lesions in the left main trunk (OR = 51.381, p = 0.044), utilization of intra-aortic balloon pumps and percutaneous cardiopulmonary support (OR = 6.141, p = 0.016), and presence of multi-vessel disease (OR = 6.323, p = 0.022).
Predictors of in-hospital death in AMI extend beyond conventional risk factors to include culprit lesions, mechanical support, and multi-vessel disease that manifest post-PCI.
年龄、生命体征、肾功能、Killip分级、心脏骤停、心脏生物标志物水平升高以及ST段偏移等因素可预测急性心肌梗死（AMI）患者的生存率。然而，现有的风险评估工具缺乏对导管相关因素的全面考虑，且短期预后预测指标尚不清楚。本研究旨在明确住院AMI患者的院内预后预测指标。
536例行经皮冠状动脉介入治疗（PCI）的AMI患者被分为非存活组（n = 36）和存活组（n = 500）。比较两组的冠状动脉危险因素、实验室检查结果、血管造影结果及临床病程。采用多因素logistic回归分析PCI术前和术后阶段的院内死亡情况。
在PCI术前阶段，多因素logistic回归分析显示了几个院内死亡的预测因素，包括收缩压[比值比（OR）= 0.985，p = 0.023]、Killip分级≥2级（OR = 14.051，p <0.001）和慢性肾脏病（OR = 4.859，p = 0.040）。在PCI术后阶段，多因素logistic回归分析显示了更多的院内死亡预测因素，包括Killip分级≥2级（OR = 5.982，p = 0.039）、左主干病变（OR = 51.381，p = 0.044）、主动脉内球囊泵和经皮心肺支持的使用（OR = 6.141，p = 0.016）以及多支血管病变（OR = 6.323，p = 0.022）。
AMI患者院内死亡的预测因素不仅包括传统危险因素，还包括PCI术后出现的罪犯病变、机械支持和多支血管病变。
