Determination of risk factors affecting the in-hospital prognosis of patients with acute ST segment elevation myocardial infarction after percutaneous coronary intervention

Background

To determine the factors affecting the in-hospital prognosis of patients with acute ST segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI), and to establish its prognostic discriminant model.

Methods

A total of 701 consecutive STEMI patients undergoing PCI were enrolled in this study. The patients were divided into two groups, good prognosis and poor prognosis, based on whether the patient had adverse outcomes (death or heart function ≥ grade III) at discharge. Demographic and basic clinical characteristics, diagnosis at admission (e.g., ventricular function, complications, or hyperlipidemia), and biomedical indicators (e.g., blood count, basal metabolism and biochemical composition, blood lipid and glucose levels, myocardial biomarkers, and coagulation) were collected and analyzed.

Results

We determined 22 factors as risk factors for the in-hospital prognosis of STEMI patients after PCI: age, cardiac function during hospitalization, complications, history of diabetes mellitus, et al., among which the history of diabetes, uric acid, urea nitrogen, and activated partial thromboplastin time (APTT) were independent risk factors.

Conclusion

We identified four independent risk factors for the in-hospital prognosis of STEMI patients after PCI and generated a prognostic model to predict the adverse outcomes of these patients.

Reference values of myocardial structure, function, and tissue composition by cardiac magnetic resonance in healthy African-Americans at 3T and their relations to serologic and cardiovascular risk factors

Cardiac magnetic resonance (CMR) is a standard of reference for cardiac structure and function. Recent advances in T1 mapping and spectroscopy also provide assessment of myocardial tissue composition. However, the reference ranges of left ventricular parameters have rarely been assessed in an African-American (AA) population without known cardiac disease. To estimate the reference values of myocardial structure, function, and tissue composition by CMR and to explore their relationships to serologic factors and cardiovascular risk factors in asymptomatic AAs with low Framingham risk, between November 2010 and June 2012, 92 healthy AAs aged ≥21 years, from Baltimore, MD, were enrolled in an observational study. CMR examination was performed on a 3T scanner. Proton magnetic resonance spectroscopy was performed to noninvasively quantify myocardial triglyceride content. Native T1 values were obtained from modified Look-Locker inversion recovery sequence. The median age was 37 (interquartile range IQR 27 to 44) years (41% men). The median native T1 time of the myocardium was 1,228 ms (IQR 1,200 to 1,263) with no gender difference. The median myocardial fat content was 0.6% (IQR 0.7% to 4.6%). Native T1 time was not influenced by age, sex, and body mass index. Among the factors investigated, myocardial fat and elevated C-reactive protein (>2.0 mg/dL) were independently associated with T1 relaxation time. Native T1 time was also independently associated with left ventricular end-diastolic volume indexed to body surface area. In conclusion, this study of asymptomatic AAs provides reference ranges for cardiovascular structure, function, and tissue composition. Alterations in myocardial fat are associated with native T1 time, a CMR measure of interstitial fibrosis.