Risk Factors for Predicting Mortality among Old Patients with Acute Myocardial Infarction during Hospitalization
DOI:
https://doi.org/10.1532/hsf.2265Abstract
Objective: To explore the risk factors to predict mortality among acute myocardial infarction (AMI) patients aged ≥ 80 years during their hospitalization.
Methods: A cohort of AMI patients aged ≥ 80 years hospitalized in our hospital were recruited from 2005 to 2014. Variables, including demographics, medical history, hemodynamic condition and laboratory results, were collected and analyzed to find risk factors predicting mortality during hospitalization.
Results: Amonga total of 384 patients enrolled in this study, the hospital mortality rate was 23.4%. By multivariable stepwise regression analysis, nine independent significant predictors associated with mortality during hospitalization were identified: history of stoke, cardiac shock, Killip class III to IV, ventricular tachycardia, pulse rate ≥ 100 bpm and EF ≤ 40% at presentation, in-hospital bleeding, initial serum creatinine concentration ≥ 177 umol/L and elevated initial WBC level. Prior angina was identified as a protective factor. Hosmer-Lemeshow test indicated good fitness of the predicting variables.
Conclusion: Patients aged 80 and over have high mortality during hospitalization, and the risk prediction factors are clinically useful for predicting mortality in old patients with AMI.
References
Addala S, Grines CL, Dixon SR, et al. 2004. Predicting mortality in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention (PAMI risk score). Am J Cardiol 93:629-32.
Anderson JL, Adams CD, Antman EM, et al. 2011. 2011 ACCF/AHA focused update incorporated into the ACC/AHA 2007 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 10:123:e426-579.
Antman EM, Cohen M, Bernink PJ, et al. 2000. The TIMI risk score for unstable angina/non–ST elevation MI: A method for prognostication and therapeutic decision making FREE. JAMA 284:835-42.
Boersma E, Pieper KS, Steyerberg EW, et al. 2000. Predictors of outcome in patients with acute coronary syndromes without persistent ST-segment elevation. Results from an international trial of 9461 patients. The PURSUIT Investigators. Circulation 101:2557-67.
Boucher JM, Racine N, Thanh TH, et al. 2001. Age-related differences in in-hospital mortality and the use of thrombolytic therapy for acute myocardial infarction. CMAJ 164:1285-90.
DeGeare VS, Stone GW, Grines L, et al. 2000. Angiographic and clinical characteristics associated with increased in-hospital mortality in elderly patients with acute myocardial infarction undergoing percutaneous intervention (A pooled analysis of the primary angioplasty in myocardial infarction trials). Am J Cardiol 86:30-4.
De Luca G, Suryapranata H, van ‘t Hof AW, et al. 2004. Prognostic assessment of patients with acute myocardial infarction treated with primary angioplasty. Implications for early discharge. Circulation 109:2737-43.
Eagle KA, Lim MJ, Dabbous OH, et al. 2004. GRACE Investigators. A validated prediction model for all forms of acute coronary syndrome. Estimating the risk of 6-month postdischarge death in an international registry. JAMA 291:2727-33.
Feldman DN, Gade CL, Slotwiner AJ, et al. 2006. Comparison of outcomes of percutaneous coronary interventions in patients of three age groups (<60, 60 to 80, and >80 years) (from the New York State Angioplasty Registry). Am J Cardiol 98:1334-9.
Granger CB, Goldberg RJ, Dabbous O, et al. 2003. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med 163:2345-53.
Grzybowski M, Welch RD, Parsons L, et al. 2004. The association between white blood cell count and acute myocardial infarction in-hospital mortality: findings from the National Registry of Myocardial Infarction. Acad Emerg Med 11:1049-60.
Hanna EB, Chen AY, Roe MT, Wiviott SD, Fox CS, Saucedo JF. 2011. Characteristics and in-hospital outcomes of patients with non-ST-segment elevation myocardial infarction and chronic kidney disease undergoing percutaneous coronary intervention. JACC Cardiovasc Interv 4:1002-8.
Krumholz HM, Chen J, Wang Y, Radford MJ, Chen YT, Marciniak TA. 1999. Comparing AMI mortality among hospitals in patients 65 years of age and older: evaluating methods of risk adjustment. Circulation 99:2986-92.
Krumholz HM, Wang Y, Chen J, et al. 2009. Reduction in acute myocardial infarction mortality in the United States risk-standardized mortality rates from 1995-2006. JAMA 302:767-73.
Kushner FG, Hand M, Smith SC Jr, et al. 2009. 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 54:2205-41.
Lee KL, Woodlief LH, Topol EJ, et al. 1995. Predictors of 30-day mortality in the era of reperfusion for acute myocardial infarction. Results from an international trial of 41,021 patients. GUSTO-I Investigators. Circulation 91:1659-68.
Mehta RH, Rathore SS, Radford MJ, Wang Y, Wang Y, Krumholz HM. 2001. Acute myocardial infarction in the elderly: differences by age. J Am Coll Cardiol 38:736-41.
Morrow DA, Antman EM, Charlesworth A, et al. 2000. TIMI risk score for ST-elevation myocardial infarction: A convenient, bedside, clinical score for risk assessment at presentation: an intravenous nPA for treatment of Infarcting Myocardium Early II Trial Substudy. Circulation 102:2031-7.
Tu JV, Austin PC, Walld R, Roos L, Agras J, McDonald KM. 2001. Development and validation of the Ontario acute myocardial infarction mortality prediction rules. J Am Coll Cardiol 37:992-7.
Webb JG, Sleeper LA, Buller CE, et al. 2000. Implications of the timing of onset of cardiogenic shock after acute myocardial infarction: a report from the SHOCK Trial Registry. Should we emergently revascularize occluded coronaries for cardiogenic shock? J Am Coll Cardiol 36:1084-90.
