Hemo-metabolic impairment in patients with ST-segment elevation myocardial infarction: Data from the INTERSTELLAR registry
, 1, 2, 1, 1, 1, 1, 1, 1, 1, 3, 4, 5, 5, 6, 6, 6, 6
Abstract
Background: Not only hemo-dynamic (HD) factors but also hemo-metabolic (HM) risk factors reflecting multi-organ injuries are considered as important prognostic factors in ST-segment elevation myocardial infarction (STEMI). However, studies regarding HM risk factors in STEMI patients are currently limited.
Method: Under analysis were 1,524 patients with STEMI who underwent primary percutaneous coronary intervention in the INTERSTELLAR registry. Patients were divided into HM (≥ 2 risk factors) and non-HM impairment groups. The primary outcome was in-hospital all-cause mortality, and the secondary outcome was 1-year all-cause mortality.
Results: Of 1,524 patients, 214 (14.0%) and 1,310 (86.0%) patients were in the HM and non-HM impairment groups, respectively. Patients with HM impairment had a higher incidence of in-hospital mortality than those without (24.3% vs. 2.7%, p < 0.001). After adjusting for confounders, HM impairment was independently associated with in-hospital mortality (inverse probability of treatment weighting [IPTW]-adjusted odds ratio: 1.81, 95% confidence interval: 1.08–3.14). In the third door-to-balloon (DTB) time tertile (≥ 82 min), HM impairment was strongly associated with in-hospital mortality. In the first DTB time tertile ( < 62 min), indicating relatively rapid revascularization, HM impairment was consistently associated with increased in-hospital mortality.
Conclusions: Hemo-metabolic impairment is significantly associated with increased risk of in-hospital and 1-year mortality in patients with STEMI. It remains a significant prognostic factor, regardless of DTB time.
Keywords: ST-segment elevation myocardial infarctionmortalityhemo-metabolic risk factorsshockdoor-to-balloon time
References
- Palmerini T, Biondi-Zoccai G, Della Riva D, et al. Clinical outcomes with drug-eluting and bare-metal stents in patients with ST-segment elevation myocardial infarction: evidence from a comprehensive network meta-analysis. J Am Coll Cardiol. 2013; 62(6): 496–504.
- Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). Circulation. 2004; 110(5): 588–636.
- Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39(2): 119–177.
- Menees DS, Peterson ED, Wang Y, et al. Door-to-balloon time and mortality among patients undergoing primary PCI. N Engl J Med. 2013; 369(10): 901–909.
- Lee WC, Fang HY, Chen HC, et al. Effect of improved door-to-balloon time on clinical outcomes in patients with ST segment elevation myocardial infarction. Int J Cardiol. 2017; 240: 66–71.
- Esposito ML, Kapur NK. Acute mechanical circulatory support for cardiogenic shock: the "door to support" time. F1000Res. 2017; 6: 737.
- Vavalle JP, van Diepen S, Clare RM, et al. Renal failure in patients with ST-segment elevation acute myocardial infarction treated with primary percutaneous coronary intervention: Predictors, clinical and angiographic features, and outcomes. Am Heart J. 2016; 173: 57–66.
- De Rosa R, Morici N, De Servi S, et al. Impact of renal dysfunction and acute kidney injury on outcome in elderly patients with acute coronary syndrome undergoing percutaneous coronary intervention. Eur Heart J Acute Cardiovasc Care. 2020 [Epub ahead of print]: 2048872620920475.
- Oh PC, Eom YS, Moon J, et al. Prognostic impact of the combination of serum transaminase and alkaline phosphatase determined in the emergency room in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. PLoS One. 2020; 15(5): e0233286.
- Huseynov A, Baumann S, Becher T, et al. Liver and cholestatic parameters as prognostic biomarkers of in-hospital MACE in patients with STEMI. Eur J Clin Invest. 2016; 46(8): 721–729.
- Eitel I, Hintze S, de Waha S, et al. Prognostic impact of hyperglycemia in nondiabetic and diabetic patients with ST-elevation myocardial infarction: insights from contrast-enhanced magnetic resonance imaging. Circ Cardiovasc Imaging. 2012; 5(6): 708–718.
- Planer D, Witzenbichler B, Guagliumi G, et al. Impact of hyperglycemia in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention: the HORIZONS-AMI trial. Int J Cardiol. 2013; 167(6): 2572–2579.
- Moon J, Suh J, Oh PC, et al. Relation of stature to outcomes in Korean patients undergoing primary percutaneous coronary intervention for acute ST-elevation myocardial infarction (from the INTERSTELLAR registry). Am J Cardiol. 2016; 118(2): 177–182.
- Hochman JS, Sleeper LA, Webb JG, et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med. 1999; 341(9): 625–634.
- Lim N, Dubois MJ, De Backer D, et al. Do all nonsurvivors of cardiogenic shock die with a low cardiac index? Chest. 2003; 124(5): 1885–1891.
- Vallabhajosyula S, Dunlay S, Prasad A, et al. Acute noncardiac organ failure in acute myocardial infarction with cardiogenic shock. J Am Coll Cardiol. 2019; 73(14): 1781–1791.
- Reynolds HR, Hochman JS. Cardiogenic shock: current concepts and improving outcomes. Circulation. 2008; 117(5): 686–697.
- Thiele H, Zeymer U, Neumann FJ, et al. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med. 2012; 367(14): 1287–1296.
- Fang L, Moore XL, Dart AM, et al. Systemic inflammatory response following acute myocardial infarction. J Geriatr Cardiol. 2015; 12(3): 305–312.
- den Uil CA, Lagrand WK, van der Ent M, et al. Impaired microcirculation predicts poor outcome of patients with acute myocardial infarction complicated by cardiogenic shock. Eur Heart J. 2010; 31(24): 3032–3039.
- Zweck E, Thayer KL, Helgestad OKL, et al. Phenotyping cardiogenic shock. J Am Heart Assoc. 2021; 10(14): e020085.
- Jentzer JC, Schrage B, Patel PC, et al. Association between the acidemia, lactic acidosis, and shock severity with outcomes in patients with cardiogenic shock. J Am Heart Assoc. 2022; 11(9): e024932.
