eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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3/2013
vol. 9
 
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abstract:

Original papers
Risk is not flat. Comprehensive approach to multidimensional risk management in ST-elevation myocardial infarction treated with primary angioplasty (ANIN STEMI Registry)

Mariusz Kruk
,
Jakub Przyłuski
,
Łukasz Kalińczuk
,
Jerzy Pręgowski
,
Edyta Kaczmarska
,
Joanna Petryka
,
Cezary Kępka
,
Paweł Bekta
,
Zbigniew Chmielak
,
Marcin Demkow
,
Andrzej Ciszewski
,
Maciej Karcz
,
Mariusz Kłopotowski
,
Adam Witkowski
,
Witold Rużyłło

Postep Kardiol Inter 2013; 9, 3 (33): 212–220
DOI: https://doi.org/10.5114/pwki.2013.37498
Online publish date: 2013/09/16
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Introduction: Current risk assessment concepts in ST-elevation myocardial infarction (STEMI) are suboptimal for guiding clinical management.

Aim: To elaborate a composite risk management concept for STEMI, enhancing clinical decision making.

Material and methods: 1995 unselected, registry patients with STEMI treated with primary percutaneous coronary intervention (pPCI) (mean age 60.1 years, 72.1% men) were included in the study. The independent risk markers were grouped by means of factor analysis, and the appropriate hazards were identified.

Results: In-hospital death was the primary outcome, observed in 95 (4.7%) patients. Independent predictors of mortality included age, leukocytosis, hyperglycemia, tachycardia, low blood pressure, impaired renal function, Killip > 1, anemia, and history of coronary disease. The factor analysis identified two significant clusters of risk markers: 1. age-anemia- impaired renal function, interpreted as the patient-related hazard; and 2. tachycardia-Killip > 1-hyperglycemia-leukocytosis, interpreted as the event-related (hemodynamic) hazard. The hazard levels (from low to high) were defined based on the number of respective risk markers. Patient-related hazard determined outcomes most significantly within the low hemodynamic hazard group.

Conclusions: The dissection of the global risk into the combination of patient- and event-related (hemodynamic) hazards allows comprehensive assessment and management of several, often contradictory sources of risk in STEMI. The cohort of high-risk STEMI patients despite hemodynamically trivial infarction face the most suboptimal outcomes under the current invasive management strategy.
keywords:

acute coronary syndrome, ST-elevation acute coronary syndrome, primary angioplasty, risk assessment
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