عنوان مقاله:

نویسندگان:

ناهید صالحی، سایه متوسلی، پریسا جانجانی، ثریا سیابانی، هومن تدبیری، مهدی نعلینی

Aim: To investigate predictors of 30-day mortality after ST-segment elevation myocardial infarction (STEMI), including reperfusion therapy, in a tertiary hospital in the west of Iran. Methods: In this registry-based cohort study (2016- 2019), we investigated reperfusion therapies— primary percutaneous coronary intervention (PPCI), pharmaco-invasive (thrombolysis followed by angiography/percutaneous coronary intervention), and thrombolysis alone—used in Imam-Ali Hospital, the only hospital with a PPCI capability in Kermanshah Province. We estimated hazard ratios and 95% confidence intervals (HRs, 95%CIs), using Cox proportional-hazard models, to investigate potential predictors of 30-day mortality including reperfusion therapy, admission types (direct admission/referral from non-PPCI-capable hospitals), demographic variables, coronary risk factors, vital signs on admission, medical history, and laboratory tests. Results: Data of 2428 STEMI patients (mean age: 60.73; 22.9% female) were available. Reperfusion therapy performed in 84% of patients (58% PPCI, 10% pharmaco-invasive, 16% thrombolysis alone). Only 17% of referred patients had received thrombolysis at non-PPCI-capable hospitals. Among patients with thrombolysis, only 38.2% underwent coronary angiography/percutaneous coronary intervention. The independent predictors of mortality were: no reperfusion therapy (HR: 2.01, 95%CI: 1.36-2.97), referral from non-PPCI-capable hospitals (1.73, 1.22-2.46), age (1.03, 1.01-1.04), glomerular filtration rate (0.97, 0.96-0.97), heart rate >100 bpm (1.94, 1.22-3.08), and systolic blood pressure<100 mmHg (4.92, 3.43-7.04). Mortality in the pharmaco-invasive approach was lower, although statistically non-significant, than other reperfusion therapies. Conclusion: Reperfusion therapy, admission types, age, glomerular filtration rate, heart rate, and blood pressure were independently associated with 30-day mortality. Using a comprehensive STEMI network to increase reperfusion therapy, especially pharmaco-invasive therapy, is recommended.

Death, myocardial reperfusion, percutaneous coronary intervention, risk factors

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صالحی، ناهید، متوسلی، سایه، جانجانی، پریسا، سیابانی، ثریا، تدبیری، هومن، نعلینی، مهدی، 1400، درمان خونرسانی مجدد و عوامل پیش بینی کننده مرگ و میر 30 روزه پس از سکته قلبی با صعود قطعه ST در یک بیمارستان سطح سه در غرب ایران، سیزدهمین کنگره قلب و عروق خاورمیانه و ششمین همایش مداخلات پیچیده قلبی، http://conf.sums.ac.ir/fa/archive_index.php?c=HN-mecc13&aid=1512538