1. Reperfusion Therapy and Predictors of 30-Day Mortality after ST-Segment Elevation Myocardial Infarction in a University Medical Center in Western Iran
- Author
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Parisa Janjani, Mahdi Nalini, Mohammad Rouzbahani, Hooman Tadbiri, Nahid Salehi, Sayeh Motevaseli, Mostafa Bahremand, Reza Heidari Moghadam, and Soraya Siabani
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Iran ,Cohort Studies ,Reperfusion therapy ,Internal medicine ,medicine ,Humans ,Thrombolytic Therapy ,Myocardial infarction ,Survival rate ,Academic Medical Centers ,business.industry ,Hazard ratio ,Percutaneous coronary intervention ,General Medicine ,Thrombolysis ,Middle Aged ,medicine.disease ,Treatment Outcome ,Blood pressure ,Reperfusion ,Cardiology ,ST Elevation Myocardial Infarction ,Female ,business ,Cohort study - Abstract
Background: Considerable variability in survival rate after ST-segment elevation myocardial infarction (STEMI) is present and outcomes remain suboptimal, especially in low- and middle-income contraries. This study aimed to investigate predictors of 30- day mortality after STEMI, including reperfusion therapy, in a tertiary hospital in western Iran. Methods: In this registry-based cohort study (2016–2019), we investigated reperfusion therapies – primary percutaneous coronary intervention (PPCI), pharmaco-invasive (thrombolysis followed by angiography/percutaneous coronary intervention), and thrombolysis alone – used in Imam-Ali hospital, the only hospital with a PPCI capability in the Kermanshah Province. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs), using Cox proportional-hazard models, to investigate the potential predictors of 30-day mortality including reperfusion therapy, admission types (direct admission/referral from non-PPCI-capable hospitals), demographic variables, coronary risk factors, vital signs on admission, medical history, and laboratory tests. Results: Data of 2428 STEMI patients (mean age: 60.73; 22.9% female) were available. Reperfusion therapy was performed in 84% of patients (58% PPCI, 10% pharmaco-invasive, 16% thrombolysis alone). Only 17% of the referred patients had received thrombolysis at non-PPCI-capable hospitals. Among patients with thrombolysis, only 38.2% underwent coronary angiography/ percutaneous coronary intervention. The independent predictors of mortality were: no reperfusion therapy (HR: 2.01, 95% CI: 1.36–2.97), referral from non-PPCI-capable hospitals (1.73, 1.22–2.46), age (1.03, 1.01–1.04), glomerular filtration rate (0.97, 0.96–0.97), heart rate>100 bpm (1.94, 1.22–3.08), and systolic blood pressure
- Published
- 2021
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