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Early survival after acute myocardial infarction with ST-segment elevation: What could be improved? Insights from France PCI French registry

Early mortality post-ST-segment elevation myocardial infarction (STEMI) in France remains high. The multicentre France Percutaneous Coronary Intervention Registry includes every patient undergoing coronary angiography in France. We analyzed the prevalence and impact of unmodifiable and modifiable ri...

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Autores principales: Duband, Benjamin, Motreff, Pascal, Marcollet, Pierre, Gamet, Alexandre, Decomis, Marie-Pascale, Bar, Olivier, Saint Etienne, Christophe, Hakim, Radwan, Canville, Alexandre, Viallard, Louis, BeyguI, Farzin, Lesault, Pierre Francois, Bonnet, Philippe, Durand, Eric, Boiffard, Emmanuel, Collet, Jean-Philippe, Benamer, Hakim, Commeau, Philippe, Cayla, Guillaume, Pereira, Bruno, Koning, Rene, Rangé, Gregoire
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9439734/
https://www.ncbi.nlm.nih.gov/pubmed/36107504
http://dx.doi.org/10.1097/MD.0000000000030190
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author Duband, Benjamin
Motreff, Pascal
Marcollet, Pierre
Gamet, Alexandre
Decomis, Marie-Pascale
Bar, Olivier
Saint Etienne, Christophe
Hakim, Radwan
Canville, Alexandre
Viallard, Louis
BeyguI, Farzin
Lesault, Pierre Francois
Bonnet, Philippe
Durand, Eric
Boiffard, Emmanuel
Collet, Jean-Philippe
Benamer, Hakim
Commeau, Philippe
Cayla, Guillaume
Pereira, Bruno
Koning, Rene
Rangé, Gregoire
author_facet Duband, Benjamin
Motreff, Pascal
Marcollet, Pierre
Gamet, Alexandre
Decomis, Marie-Pascale
Bar, Olivier
Saint Etienne, Christophe
Hakim, Radwan
Canville, Alexandre
Viallard, Louis
BeyguI, Farzin
Lesault, Pierre Francois
Bonnet, Philippe
Durand, Eric
Boiffard, Emmanuel
Collet, Jean-Philippe
Benamer, Hakim
Commeau, Philippe
Cayla, Guillaume
Pereira, Bruno
Koning, Rene
Rangé, Gregoire
author_sort Duband, Benjamin
collection PubMed
description Early mortality post-ST-segment elevation myocardial infarction (STEMI) in France remains high. The multicentre France Percutaneous Coronary Intervention Registry includes every patient undergoing coronary angiography in France. We analyzed the prevalence and impact of unmodifiable and modifiable risk factors on 30-day survival in patients experiencing STEMI. Patients admitted for STEMI between 01/2014 and 12/2016 were included in the analysis. Patients with nonobstructive coronary artery disease, with cardiogenic shock or cardiac arrest without STEMI, were excluded. Prehospital, clinical and procedural data were collected prospectively by the cardiologist in the cath lab using medical reporting software. Information on outcomes, including mortality, was obtained by a dedicated research technician by phone calls or from medical records. Marginal Cox proportional hazards regression was used to test the predictive value for survival at 30 days in a multivariable analysis. Included were 2590 patients (74% men) aged 63 ± 14 years. During the first month, 174 patients (6.7%) died. After adjustment, unmodifiable variables significantly associated with reduced 30-day survival were: age > 80 years (prevalence 15%; hazard ratio [HR] 2.7; 95% confidence interval [CI] 1.5–4.7), chronic kidney disease (2%; HR 5.3; 95% CI 2.6–11.1), diabetes mellitus (14%; HR 1.6; 95% CI 1.0–2.5), anterior or circumferential electrical localization (39%; HR 2.0; 95% CI 1.4–2.9), and Killip class 2, 3, or 4 (7%; HR 3.4; 95% CI 1.9–5.9; 2%; HR 10.1; 95% CI 5.3–19.4; 4%; HR 18; 95% CI 10.8–29.8, respectively). Among modifiable variables, total ischemic time > 3 hours (68%; HR 1.8; 95% CI 1.1–3.0), lack of appropriate premedication (18%; HR 2.2; 95% CI 1.5–3.3), and post-PCI TIMI < 3 (6%; HR 4.9; 95% CI 3.2–7.6) were significantly associated with reduced 30-day survival. Most predictors of 30-day survival post-STEMI are unmodifiable, but outcomes might be improved by optimizing modifiable factors, most importantly ischemic time and appropriate premedication.
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spelling pubmed-94397342022-09-06 Early survival after acute myocardial infarction with ST-segment elevation: What could be improved? Insights from France PCI French registry Duband, Benjamin Motreff, Pascal Marcollet, Pierre Gamet, Alexandre Decomis, Marie-Pascale Bar, Olivier Saint Etienne, Christophe Hakim, Radwan Canville, Alexandre Viallard, Louis BeyguI, Farzin Lesault, Pierre Francois Bonnet, Philippe Durand, Eric Boiffard, Emmanuel Collet, Jean-Philippe Benamer, Hakim Commeau, Philippe Cayla, Guillaume Pereira, Bruno Koning, Rene Rangé, Gregoire Medicine (Baltimore) Research Article Early mortality post-ST-segment elevation myocardial infarction (STEMI) in France remains high. The multicentre France Percutaneous Coronary Intervention Registry includes every patient undergoing coronary angiography in France. We analyzed the prevalence and impact of unmodifiable and modifiable risk factors on 30-day survival in patients experiencing STEMI. Patients admitted for STEMI between 01/2014 and 12/2016 were included in the analysis. Patients with nonobstructive coronary artery disease, with cardiogenic shock or cardiac arrest without STEMI, were excluded. Prehospital, clinical and procedural data were collected prospectively by the cardiologist in the cath lab using medical reporting software. Information on outcomes, including mortality, was obtained by a dedicated research technician by phone calls or from medical records. Marginal Cox proportional hazards regression was used to test the predictive value for survival at 30 days in a multivariable analysis. Included were 2590 patients (74% men) aged 63 ± 14 years. During the first month, 174 patients (6.7%) died. After adjustment, unmodifiable variables significantly associated with reduced 30-day survival were: age > 80 years (prevalence 15%; hazard ratio [HR] 2.7; 95% confidence interval [CI] 1.5–4.7), chronic kidney disease (2%; HR 5.3; 95% CI 2.6–11.1), diabetes mellitus (14%; HR 1.6; 95% CI 1.0–2.5), anterior or circumferential electrical localization (39%; HR 2.0; 95% CI 1.4–2.9), and Killip class 2, 3, or 4 (7%; HR 3.4; 95% CI 1.9–5.9; 2%; HR 10.1; 95% CI 5.3–19.4; 4%; HR 18; 95% CI 10.8–29.8, respectively). Among modifiable variables, total ischemic time > 3 hours (68%; HR 1.8; 95% CI 1.1–3.0), lack of appropriate premedication (18%; HR 2.2; 95% CI 1.5–3.3), and post-PCI TIMI < 3 (6%; HR 4.9; 95% CI 3.2–7.6) were significantly associated with reduced 30-day survival. Most predictors of 30-day survival post-STEMI are unmodifiable, but outcomes might be improved by optimizing modifiable factors, most importantly ischemic time and appropriate premedication. Lippincott Williams & Wilkins 2022-09-02 /pmc/articles/PMC9439734/ /pubmed/36107504 http://dx.doi.org/10.1097/MD.0000000000030190 Text en Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC) (https://creativecommons.org/licenses/by-nc/4.0/) , where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.
spellingShingle Research Article
Duband, Benjamin
Motreff, Pascal
Marcollet, Pierre
Gamet, Alexandre
Decomis, Marie-Pascale
Bar, Olivier
Saint Etienne, Christophe
Hakim, Radwan
Canville, Alexandre
Viallard, Louis
BeyguI, Farzin
Lesault, Pierre Francois
Bonnet, Philippe
Durand, Eric
Boiffard, Emmanuel
Collet, Jean-Philippe
Benamer, Hakim
Commeau, Philippe
Cayla, Guillaume
Pereira, Bruno
Koning, Rene
Rangé, Gregoire
Early survival after acute myocardial infarction with ST-segment elevation: What could be improved? Insights from France PCI French registry
title Early survival after acute myocardial infarction with ST-segment elevation: What could be improved? Insights from France PCI French registry
title_full Early survival after acute myocardial infarction with ST-segment elevation: What could be improved? Insights from France PCI French registry
title_fullStr Early survival after acute myocardial infarction with ST-segment elevation: What could be improved? Insights from France PCI French registry
title_full_unstemmed Early survival after acute myocardial infarction with ST-segment elevation: What could be improved? Insights from France PCI French registry
title_short Early survival after acute myocardial infarction with ST-segment elevation: What could be improved? Insights from France PCI French registry
title_sort early survival after acute myocardial infarction with st-segment elevation: what could be improved? insights from france pci french registry
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9439734/
https://www.ncbi.nlm.nih.gov/pubmed/36107504
http://dx.doi.org/10.1097/MD.0000000000030190
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