2
|
Han L, Yan F, Zhang Y, Pan Y, Li S, Yang M, Wang Y, Yanru C, Su W, Ma Y. Prevalence and associated factors of mortality after percutaneous coronary intervention for adult patients with ST-elevation myocardial infarction: A systematic review and meta-analysis. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2023; 28:17. [PMID: 37064794 PMCID: PMC10098139 DOI: 10.4103/jrms.jrms_781_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/13/2022] [Accepted: 11/17/2022] [Indexed: 03/18/2023]
Abstract
Background There is a paucity of systematic reviews on the associated factors of mortality among ST-elevation myocardial infarction (STEMI) patients after percutaneous coronary intervention (PCI). This meta-analysis was designed to synthesize available evidence on the prevalence and associated factors of mortality after PCI for adult patients with STEMI. Materials and Methods Databases including the Cochrane Library, PubMed, Web of Science, Embase, Ovid, Scopus, ProQuest, MEDLINE, and CINAHL Complete were searched systematically to identify relevant articles published from January 2008 to March 2020 on factors affecting mortality after PCI in STEMI patients. Meta-analysis was conducted using Stata 12.0 software package. Results Our search yielded 91 cohort studies involving a total of 199, 339 participants. The pooled mortality rate for STEMI patients after PCI was 10%. After controlling for grouping criteria or follow-up time, the following 17 risk factors were significantly associated with mortality for STEMI patients after PCI: advanced age (odds ratio [OR] = 3.89), female (OR = 2.01), out-of-hospital cardiac arrest (OR = 5.55), cardiogenic shock (OR = 4.83), renal dysfunction (OR = 3.50), admission anemia (OR = 3.28), hyperuricemia (OR = 2.71), elevated blood glucose level (OR = 2.00), diabetes mellitus (OR = 1.8), chronic total occlusion (OR = 2.56), Q wave (OR = 2.18), without prodromal angina (OR = 2.12), delay in door-to-balloon time (OR = 1.72), delay in symptom onset-to-balloon time (OR = 1.43), anterior infarction (OR = 1.66), ST-segment resolution (OR = 1.40), and delay in symptom onset-to-door time (OR = 1.29). Conclusion The pooled prevalence of mortality after PCI for STEMI patients was 10%, and 17 risk factors were significantly associated with mortality for STEMI patients after PCI.
Collapse
|
3
|
Ekström K, Nielsen JVW, Nepper-Christensen L, Ahtarovski KA, Kyhl K, Göransson C, Bertelsen L, Ghotbi AA, Kelbæk H, Høfsten DE, Køber L, Schoos MM, Vejlstrup N, Lønborg J, Engstrøm T. Ischemia From Nonculprit Stenoses Is Not Associated With Reduced Culprit Infarct Size in Patients with ST-Segment-Elevation Myocardial Infarction. Circ Cardiovasc Imaging 2021; 14:e012290. [PMID: 33951923 DOI: 10.1161/circimaging.120.012290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In patients with ST-segment-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention, reperfusion injury accounts for a significant fraction of the final infarct size, which is directly related to patient prognosis. In animal studies, brief periods of ischemia in noninfarct-related (nonculprit) coronary arteries protect the culprit myocardium via remote ischemic preconditioning. Positive fractional flow reserve (FFR) documents functional significant coronary nonculprit stenosis, which may offer remote ischemic preconditioning of the culprit myocardium. The aim of the study was to investigate the association between functional significant, multivessel disease (MVD) and reduced culprit final infarct size or increased myocardial salvage (myocardial salvage index [MSI]) in a large contemporary cohort of STEMI patients. METHODS Cardiac magnetic resonance was performed in 610 patients with STEMI at day 1 and 3 months after primary percutaneous coronary intervention. Patients were stratified into 3 groups according to FFR measurements in nonculprit stenosis (if any): angiographic single vessel disease (SVD), FFR nonsignificant MVD (functional SVD), or FFR-significant, functional MVD. RESULTS A total of 431 (71%) patients had SVD, 35 (6%) had functional SVD, and 144 (23%) had functional MVD. There was no difference in final infarct size (mean infarct size [%left ventricular mass] SVD, 9±3%; functional SVD, 9±3%; and functional MVD, 9±3% [P=0.82]) or in MSI between groups (mean MSI [%left] SVD, 66±23%; functional SVD, 68±19%; and functional MVD, 69±19% [P=0.62]). In multivariable analyses, functional MVD was not associated with larger MSI (P=0.56) or smaller infarct size (P=0.55). CONCLUSIONS Functional MVD in nonculprit myocardium was not associated with reduced culprit final infarct size or increased MSI following STEMI. This is important knowledge for future studies examining a cardioprotective treatment in patients with STEMI, as a possible confounding effect of FFR-significant, functional MVD can be discarded. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01435408 (DANAMI 3-iPOST and DANAMI 3-DEFER) and NCT01960933 (DANAMI 3-PRIMULTI).
Collapse
Affiliation(s)
- Kathrine Ekström
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.)
| | - Julie V W Nielsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.)
| | - Lars Nepper-Christensen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.)
| | - Kiril A Ahtarovski
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.)
| | - Kasper Kyhl
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.)
| | - Christoffer Göransson
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.)
| | - Litten Bertelsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.)
| | - Adam A Ghotbi
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.)
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (H.K.)
| | - Dan E Høfsten
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.)
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.)
| | - Mikkel M Schoos
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.)
| | - Niels Vejlstrup
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.)
| | - Jacob Lønborg
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.)
| | - Thomas Engstrøm
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.)
- Department of Cardiology, Lund University Hospital, Sweden (T.E.)
| |
Collapse
|