BACKGROUND: Cardiogenic shock (CS) after acute myocardial infarction (AMI) develops in 5~10% of patients and it is associated with high mortality. The aim of this study is to assess the predictive factors of mortality for patients with AMI and CS. METHODS: Two hundred fifty five AMI patients with CS (the mean age was 66.0 +/- 11.0 years, M: F=156: 99) out of 1, 268 AMI patients who admitted at Chonnam National University Hospital between July 2000 and June 2002 were analyzed according to the clinical characteristics, coronary angiographic findings and MACE during admission and for the 1-year clinical follow-up. RESULTS: Among the enrolled patients, 129 patients survived without MACE (Group I, mean age 64.2 +/- 10.6 years, M: F=76: 53), and 126 patients had MACE (Group II, mean age 68.1 +/- 10.0 years, M: F=80: 46) during admission or during the 1-year follow-up period. There were significant differences in age between the Groups I and II (64.2 +/- 10.6 vs. 68.1 +/- 11.0 years, respectively, p=0.004) and the previous MI history (0 vs. 17.4%, respectively, p< 0.001). The left ventricular ejection fraction (EF) was lower in Group II (Group I vs. II: 49.1 +/- 13.0 vs. 39.1 +/- 12.9%, p< 0.001). The levels of troponin (Tn) I and C-reactive protein (CRP) were higher in Group II (Group I vs. II: 29.2 +/- 7.72 vs. 50.8 +/- 5.17 ng/dL, p=0.017, 3.8 +/- 0.48 vs. 9.9 +/- 1.21 mg/dL, p< 0.001 respectively). Left main stem lesion (LMSL) was more common in Group II than in Group I (0.7% vs. 22.0%, respectively, p=0.004). In-hospital death was associated with low Thrombolysis In Myocardial Infarction (TIMI) flow after coronary revascularization. CONCLUSION: Old age, a previous MI history, high Tn and CRP, low EF and LMSL are associated with higher MACE for patients with AMI and CS. Coronary revascularization with TIMI 3 flow lowers the in-hospital mortality.
Aged ; Female ; Hospital Mortality ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Myocardial Infarction/complications/*mortality ; Prognosis ; Shock, Cardiogenic/etiology/*mortality

BACKGROUNDThe most appropriate surgical approach for patients with post-infarction left ventricular (LV) aneurysm remains undetermined. We compared the efficacy of the linear versus patch repair techniques, and investigated the mid-term changes of LV geometry and cardiac function, for repair of LV aneurysms.

METHODSWe reviewed the records of 194 patients who had surgery for a post-infarction LV aneurysm between 1998 and 2010. Short-term and mid-term outcomes, including complications, cardiac function and mortality, were assessed. LV end-diastolic and systolic dimensions (LVEDD and LVESD), LV end-diastolic and end-systolic volume indexes (LVEDVI and LVESVI) and LV ejection fraction (LVEF) were measured on pre-operative and follow-up echocardiography.

RESULTSOverall in-hospital mortality was 4.12%, and major morbidity showed no significant differences between the two groups. Multivariate analysis identified preoperative left ventricular end diastolic pressure > 20 mmHg, low cardiac output and aortic clamping time > 2 hours as risk factors for early mortality. Follow-up revealed that LVEF improved from 37% pre-operation to 45% 12 months post-operation in the patch group (P = 0.008), and from 44% pre-operation to 40% 12 months postoperation in the linear group (P = 0.032). In contrast, the LVEDVI and LVESVI in the linear group were significantly reduced immediately after the operation, and increased again at follow-up. However, in the patch group, the LVEDVI and LVESVI were significantly reduced at follow-up. And there were significant differences in the correct value changes of LVEF and left ventricular remodeling between linear repair and patch groups.

CONCLUSIONSPersistent reduction of LV dimensions after the patch repair procedure seems to be a procedure-related problem. The choice of the technique should be tailored on an individual basis and surgeon's preference. The patch remodeling technique results in a better LVEF improvement, further significant reductions in LV dimensions and volumes than does the linear repair technique. The results suggest that LV patch remodeling is a better surgical choice for patients with post-infarction LV aneurysm.

Aged ; Female ; Heart Aneurysm ; etiology ; mortality ; surgery ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; complications ; mortality ; surgery ; Ventricular Remodeling

OBJECTIVETo evaluate the outcome of ST-elevation acute myocardial infarction (STEMI) patients complicated pre-hospital cardiac arrest underwent percutaneous coronary intervention (PCI).

METHODSFrom September 2004 to November 2008, 1446 consecutive patients with acute STEMI underwent PCI in our department. 49 out of 1446 patients complicated by pre-hospital cardiac arrest. Clinical outcome including total mortality, adverse cardiac events, stroke and bleeding events during the hospitalization period and within 1 year after discharge was compared between patients with or without pre-hospital cardiac arrest.

RESULTSPCI success rate was similar (85.7% vs. 88.8%, P = 0.497) while the incidence of in-hospital cardiogenic shock 22.4% vs. 3.0%, P < 0.001 and cardiac arrest (44.9% vs. 5.9%, P < 0.001) and in-hospital mortality (36.7% vs. 2.0%, P < 0.001) were significantly higher in patients with pre-hospital cardiac arrest than patients without pre-hospital cardiac arrest. Time from symptom onset to emergency treatment, asystole as initial rhythm, Glasgow coma scale (GCS ≤ 7) and cardiogenic shock on admission were independent risk factors of in-hospital death in patients with pre-hospital cardiac arrest. During follow up, incidences of overall mortality, re-infarction, revascularization and stroke were similar between the two groups.

CONCLUSIONSSTEMI patients with pre-hospital cardiac arrest undergoing emergency PCI are facing higher risk of cardiogenic shock and cardiac arrest and higher in-hospital mortality compared to those without pre-hospital cardiac arrest. However, the post-hospital discharge outcome was similar between the two groups.

Adult ; Aged ; Angioplasty, Balloon, Coronary ; Emergency Treatment ; Female ; Heart Arrest ; complications ; therapy ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; complications ; mortality ; therapy ; Treatment Outcome

Objective: To compare the clinical features and the outcome of in-hospital mortality between patients with myocardial infarction with non-obstructive coronary arteries(MINOCA)and myocardial infarction with obstructive coronary artery disease (MI-CAD). Methods: This is a retrospective study. The clinical data of acute myocardial infarction (AMI) patients admitted to Qilu Hospital of Shandong University from January 2017 to May 2021, who underwent coronary angiography, were collected. Patients were divided into MINOCA group and MI-CAD group according to the degree of coronary stenosis (<50% or ≥50%). Baseline clinical characteristics, electrocardiograph during hospitalization, myocardial bridge, length of stay in hospital, discharge medication and the outcome of in-hospital mortality were collected and compared between the two groups. Univariate and multivariate logistic regression analysis was used to screen the related factors of MINOCA and the factors predicting the nosocomial death outcome of patients with AMI. Results: A total of 3 048 AMI patients were enrolled, age was 62 (54, 69) years, 741 (24.3%) patients were women including 165 patients (5.4%) in the MINOCA group and 2 883 patients (94.6%) in the MI-CAD group. Compared with MI-CAD patients, MINOCA patients were younger, had a higher proportion of females and a higher incidence of NSTEMI, and had a lower history of smoking, diabetes, coronary heart disease and myocardial infarction. Baseline inflammatory markers such as neutrophil count, monocyte count, neutrophil count/lymphocyte count (NLR), and monocyte count/high-density lipoprotein count (MHR) were lower, creatinine, N-terminal pro-brain B-type Natriuretic peptides (NT-proBNP), creatine kinase-MB, hypersensitive troponin I, fibrinogen, baseline blood glucose levels were lower, high-density lipoprotein cholesterol was higher, and the incidence of myocardial bridge, arrhythmia, tachycardia and atrial fibrillation was higher (P<0.05). The application rates of calcium antagonists and non-vitamin K antagonists oral anticoagulants were higher in MINOCA group (P<0.05), and there was no statistical difference in hospitalization days and in-hospital death between the two groups (P>0.05). Multiple logistic regression analysis showed that young age, female, non-smoker, no history of coronary heart disease and low MHR were risk factors of MINOCA (P<0.05). MINCOA was not associated with higher in-hospital death (P>0.05). Patients with AMI and a history of coronary heart disease, chronic renal failure, higher baseline blood glucose, higher NLR, and higher D-dimer were risk factors of in-hospital death (P<0.05). Conclusions: Compared with MI-CAD patients, MINOCA patients are younger, more likely to be female and non-smokers and on history of coronary heart disease, and have lower baseline MHR. MINOCA is often associated with myocardial bridge and atrial fibrillation. The incidence of in-hospital death in MINCOA patients is similar as in MI-CAD patients.
Atrial Fibrillation/complications* ; Blood Glucose ; Coronary Artery Disease/complications* ; Female ; Hospital Mortality ; Humans ; Lipoproteins, HDL ; MINOCA ; Male ; Myocardial Infarction/complications* ; Retrospective Studies

OBJECTIVETo evaluate the clinical outcomes of patients with acute myocardial infarction (AMI) complicating cardiogenic shock underwent various treatments.

METHODSFrom January, 2002 to May, 2007, 47 AMI patients with cardiogenic shock were treated in our department by optimal medication (dopamine, epinephrine, norepinephrine, etc.), intra-aortic balloon pump (IABP), mechanical ventilation when indicated, percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). Outcome and factors related to mortality for these patients were analyzed in this retrospective study.

RESULTSBesides optimal medication and IABP in all patients, 31 patients underwent PCI (66.0%), 6 patients received emergency CABG (12.8%). The overall in-hospital mortality rate was 36.2% (17/47), 6 patients (14.9%) died before coronary revascularization and 11 patients (21.3%) died after revascularization. Nine patients died of pump failure and 8 patients died of renal and (or) respiratory failure. Regression analysis showed that acute renal failure (r = 0.734, P = 0.000), acute respiratory failure (r = 0.606, P = 0.000) and diabetes (r = 0.372, P = 0.012) were positively related to in-hospital mortality.

CONCLUSIONDespite improvements in treatment options for AMI patients complicating cardiogenic shock, in-hospital mortality remained high, especially for patients complicating further with acute renal failure and acute respiratory failure.

Adult ; Aged ; Aged, 80 and over ; Cause of Death ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; complications ; mortality ; therapy ; Prognosis ; Retrospective Studies ; Shock, Cardiogenic ; etiology ; mortality ; therapy ; Treatment Outcome

OBJECTIVETo explore the independent risk factors associated with short term mortality in patients with ST-segment elevation acute myocardial infarction (STEMI) complicated by cardiogenic shock (CS).

METHODSWe analyzed data from Chinese patients with ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock enrolled in the CREATE trial. Predictors of 30-day mortality were identified by univariate and multivariate logistic regression analysis using baseline and procedural variables.

RESULTSThe overall 30-day mortality of STEMI complicated by CS among the 517 patients [(68.5 ± 10.3) years and 57.6% male] was 62.3%. Logistic regression analysis showed that the independent risk factors of death included age (OR = 1.46, 95%CI: 1.18 - 1.81), anterior infarction (OR = 2.01, 95%CI 1.29 - 3.11), admission glucose level > 7.8 mmol/L (OR = 2.17, 95%CI: 1.26 - 3.73), serum sodium concentration < 130 mmol/L (OR = 2.21, 95%CI: 1.21 - 4.04), left ventricular ejection fraction (LVEF) < 40% or sever left ventricular dysfunction (LVD) (OR = 3.78, 95%CI: 2.28 - 6.27), no emergency revascularization (OR = 3.53, 95%CI: 1.20 - 10.41) and diuretics use (OR = 1.90, 95%CI: 1.21 - 2.97). Analysis using baseline clinical variables showed that the first five risk factors mentioned above were also the baseline risk factors fro death. The receiver operating characteristic curve for predicting the death of the two models was 0.81 (95%CI: 0.77 - 0.86) and 0.80 (95%CI: 0.75 - 0.84), respectively.

CONCLUSIONThe 30-day mortality of patients with STEMI complicated by CS was over 60%. Age, anterior infarction, admission glucose level >7.8 mmol/L, serum sodium concentration < 130 mmol/L, left ventricular ejection fraction (LVEF) < 40% and no emergency revascularization were independent risk factors associated with 30-day mortality.

Aged ; China ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Myocardial Infarction ; complications ; mortality ; therapy ; Prognosis ; Risk Factors ; Shock, Cardiogenic ; etiology ; mortality ; therapy ; Survival Rate ; Treatment Outcome

BACKGROUNDCardiac arrest is one of the most serious complications of acute myocardial infarction (AMI), especially in the out-of-hospital patients. There is no general consensus as to whether percutaneous coronary intervention (PCI) is effective in treating ST-segment elevation myocardial infarction (STEMI) patients complicated by out-of-hospital cardiac arrest (OHCA). In our study, we evaluated the efficacy of PCI in treating STEMI patients complicated by OHCA through observing their clinical conditions in hospital; including total mortality, adverse cardiac events, stroke, acute renal failure, and gastrointestinal bleeding events.

METHODSA total of 1827 STEMI patients were enrolled in this study, where 81 were STEMI with OHCA. Between the patients with and without OHCA, and the OHCA patients with and without PCI, we compared the clinical characteristics during hospitalization, including total mortality and incidences of adverse cardiac events, and stroke.

RESULTSCompared to the patients without OHCA, the OHCA patients had significantly lower systolic blood pressure (P < 0.05) and a faster heart rate (P < 0.05), and a higher percentage of Killip class IV or Glasgow coma scale (GCS) ≤ 7 on admission (P < 0.001). And the in-hospital mortality was higher in the OHCA patients (55.6% vs. 2.4%, P < 0.001). Comparing the OHCA patients without PCI to the patients with PCI, there was no obvious difference of heart rate, blood pressure or the percentage of Killip class IV and GCS ≤ 7 on admission, but the incidences of cardiogenic shock, stroke were significantly lower in the with-PCI group during hospitalization (P < 0.001, P < 0.05). And the in-hospital mortality of the OHCA patients receiving PCI was significantly lower (36.7% vs. 84.3%, P < 0.001).

CONCLUSIONSDuring hospitalization, the incidence of adverse events and mortality are higher in the STEMI with OHCA patients, comparing with the STEMI without OHCA. Emergency PCI reduces the incidence of adverse events and decreases mortality during hospitalization, which is effective for treating STEMI with OHCA patients.

Adult ; Aged ; Angioplasty, Balloon, Coronary ; Electrocardiography ; Emergencies ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; complications ; mortality ; therapy ; Out-of-Hospital Cardiac Arrest ; etiology

Heart failure (HF) complicating acute myocardial infarction (AMI) is common and is associated with poor clinical outcome. Limited data exist regarding the incidence and in-hospital mortality of AMI with HF (AMI-HF). We retrospectively analyzed 1,427 consecutive patients with AMI in the five major university hospitals in Korea at two time points, 1998 (n = 608) and 2008 (n = 819). Two hundred twenty eight patients (37.5%) in 1998 and 324 patients (39.5%) in 2008 of AMI patients complicated with HF (P = 0.429). AMI-HF patients in 2008 were older, had more hypertension, previous AMI, and lower systolic blood pressure than those in 1998. Regarding treatments, AMI-HF patients in 2008 received more revascularization procedures, more evidence based medical treatment and adjuvant therapy, such as mechanical ventilators, intra-aortic balloon pulsation compared to those in 1998. However, overall in-hospital mortality rates (6.4% vs 11.1%, P = 0.071) of AMI-HF patients were unchanged and still high even after propensity score matching analysis, irrespective of types of AMI and revascularization methods. In conclusion, more evidence-based medical and advanced procedural managements were applied for patients with AMI-HF in 2008 than in 1998. However the incidence and in-hospital mortality of AMI-HF patients were not significantly changed between the two time points.
Acute Disease ; Age Factors ; Aged ; Blood Pressure ; Demography ; Female ; Heart Failure/complications/*diagnosis/mortality ; Hospital Mortality/*trends ; Humans ; Hypertension/complications ; Male ; Middle Aged ; Myocardial Infarction/complications/*diagnosis/mortality ; Odds Ratio ; Republic of Korea ; Retrospective Studies

PURPOSE: This study aimed to compare the incidence and clinical significance of transient versus persistent acute kidney injury (AKI) on acute ST elevation myocardial infarction (STEMI). MATERIALS AND METHODS: The study was a retrospective cohort of 855 patients with STEMI. AKI was defined as an increase of > or =0.3 mg/dL in creatinine level at any point during hospital stay. The study population was classified into 5 groups: 1) patients without AKI; 2) patients with mild AKI that was resolved by discharge (creatinine change less than 0.5mg/dL compared with admission creatinine during hospital stay, transient mild AKI); 3) patients with mild AKI that did not resolve by discharge (persistent mild AKI); 4) patients with moderate/severe AKI that was resolved by discharge (creatinine change more than 0.5 mg/dL compared with admission creatinine, transient moderate/severe AKI); 5) patients with moderate/severe AKI that did not resolve by discharge (persistent moderate/severe AKI). We investigated 1-year all-cause mortality after hospital discharge for the primary outcome of the study. The relation between AKI and 1-year mortality after STEMI was analyzed. RESULTS: AKI occurred in 74 (8.7%) patients during hospital stay. Adjusted hazard ratio for mortality was 3.139 (95% CI 0.764 to 12.897, p=0.113) in patients with transient, mild AKI, and 8.885 (95% CI 2.710 to 29.128, p<0.001) in patients with transient, moderate/severe AKI compared to patients without AKI. Persistent moderate/severe AKI was also independent predictor of 1 year mortality (hazard ratio, 5.885; 95% CI 1.079 to 32.101, p=0.041). CONCLUSION: Transient and persistent moderate/severe AKI during acute myocardial infarction is strongly related to 1-year all cause mortality after STEMI.
Acute Kidney Injury/complications/diagnosis/*epidemiology ; Aged ; Creatinine/blood ; Electrocardiography ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Myocardial Infarction/*complications/diagnosis/mortality ; Prognosis ; Retrospective Studies

PURPOSE: Limited data are available on the role of percutaneous cardiopulmonary support (PCPS) for the treatment of acute myocardial infarction (AMI) patients with cardiogenic shock. We investigated the clinical outcomes and predictors of in-hospital mortality after PCPS in patients with AMI complicated by severe refractory cardiogenic shock. MATERIALS AND METHODS: From January 2004 to December 2011, we analyzed data from 96 consecutive AMI patients with cardiogenic shock assisted by a PCPS system. The primary outcome was in-hospital mortality. The predictors of in-hospital mortality were determined by a Cox proportional-hazards model. RESULTS: In-hospital mortality occurred in 51 (53.1%) patients and 58 (60.4%) patients were able to be weaned from PCPS. Cardiopulmonary resuscitation (CPR) was performed in 61 (63.5%) patients before PCPS initiation. On multivariate analysis, age > or =67 years [adjusted hazard ratio (HR), 4.74; 95% confidence interval (CI), 2.27-9.93; p<0.001], CPR (adjusted HR, 2.32; 95% CI, 1.11-4.85; p=0.03), lactate clearance for 48 hours <70% (adjusted HR, 2.50; 95% CI, 1.04-6.05; p=0.041), and unsuccessful revascularization (adjusted HR, 3.57; 95% CI, 1.85-6.90; p=0.002) were independent predictors of in-hospital mortality after PCPS in patients with AMI complicated by cardiogenic shock. CONCLUSION: In spite of PCPS management, AMI patients complicated by severe refractory cardiogenic shock demonstrated high mortality. Older age, CPR, lower lactate clearance for 48 hours, and unsuccessful revascularization were independent predictors of in-hospital mortality.
Aged ; Cardiopulmonary Bypass ; Cardiopulmonary Resuscitation ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/*complications/*mortality/surgery/therapy ; Shock, Cardiogenic/*complications ; Treatment Outcome