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Postepy Kardiol Interwencyjnej. 2013;9(3):212-20. doi: 10.5114/pwki.2013.37498. Epub 2013 Sep 16.

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

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  • 1Coronary Disease and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland.
  • 2Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.

Abstract

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:

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

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