RISK FACTORS TO ASSESS IN-HOSPITAL MORTALITY OF STEMI PATIENTS AFTER PRIMARY PCI FAST AND EFFECTIVELY

Wei Zhang¹, Lei Qi², Jianghua Xue³, Xinyun Li¹, Fengli Du¹, Xiangru Wang¹, Hongyan Zhao^{1, *}

¹Department of Cardiology, Jinan Central Hospital Affiliated to Shandong University, Jinan, 250013, Shandong, China - ²Department of Emergency, Jinan Central Hospital Affiliated to Shandong University, Jinan, 250013, Shandong, China - ³Department of Intervention, Jinan Central Hospital Affiliated to Shandong University, Jinan, 250013, Shandong, China

Background: For patients with non ST-elevation acute coronary syndromes,GRACE score is useful for evaluating the in-hospital mortality.However, for patients with ST-elevation myocardial infarction(STEMI) after primary percutaneous coronary intervention(PCI), the major factors predicting death in hospital are still uncertain.

Hypothesis: Immediate and effective assessment of in-hospital mortality of STEMI after primary PCI.

Methods: After exclusion of 80 patients,556 STEMI patients performed primary PCI were enrolled respectively, They were divided into two groups: the survival group(n=523, 94.10%) and the death group(n=33, 5.90%). After the patients’ data collected, risk factors of predicting mortality were investigated and then receiver operating curve(ROC) was performed to determine their degree of accuracy.The maximum of Youden index was calculated to determine the cut-off values of the risk factors. 

Results: (1). Ten factors were determined to be possible risk factors. Among these factors, age (P=0.027, OR=1.061, 95%CI: 1.007~1.118), sustained symptoms (P=0.029, OR=8.643, 95%CI: 1.246~59.930), cardiac function classification before PCI (P=0.005) and white blood cell count (P=0.010, OR=1.221, 95%CI: 1.050~1.420) were independent risk factors to predict mortality in hospital. (2). The multivariable Cox survival curve was performed. 24 patients (72.73%) died within 24 hours after admission. The major causes of death were heart failure, cardiac shock and ventricular arrhythmia accounting for 81.82%. (3). The areas under ROC of age, sustained symptom, killip classification and white blood cell count were 0.679,0.408,0.791,0.728 separately. (4). The cut-off value of age (72.5 years old), killip classification (killip II grade) and white blood cell count (11.945^*109/l) were determined. 

Conclusion: We identified four independent risk factors to predict mortality of STEMI patients after primary PCI in hospital. Among theses factors, age, killip classification and white blood cell count are more accurate.