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Incidence and Predictors of Adverse Events Among Initially Stable ST‐Elevation Myocardial Infarction Patients Following Primary Percutaneous Coronary Intervention

BACKGROUND: Cardiac intensive care units were originally created in the prerevascularization era for the early recognition of ventricular arrhythmias following a myocardial infarction. Many patients with stable ST‐segment–elevation myocardial infarction (STEMI) are still routinely triaged to cardiac...

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Autores principales: Amon, Jaihoon, Wong, Graham C., Lee, Terry, Singer, Joel, Cairns, John, Shavadia, Jay S., Granger, Christopher, Gin, Kenneth, Wang, Tracy Y., van Diepen, Sean, Fordyce, Christopher B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9496426/
https://www.ncbi.nlm.nih.gov/pubmed/36056738
http://dx.doi.org/10.1161/JAHA.122.025572
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author Amon, Jaihoon
Wong, Graham C.
Lee, Terry
Singer, Joel
Cairns, John
Shavadia, Jay S.
Granger, Christopher
Gin, Kenneth
Wang, Tracy Y.
van Diepen, Sean
Fordyce, Christopher B.
author_facet Amon, Jaihoon
Wong, Graham C.
Lee, Terry
Singer, Joel
Cairns, John
Shavadia, Jay S.
Granger, Christopher
Gin, Kenneth
Wang, Tracy Y.
van Diepen, Sean
Fordyce, Christopher B.
author_sort Amon, Jaihoon
collection PubMed
description BACKGROUND: Cardiac intensive care units were originally created in the prerevascularization era for the early recognition of ventricular arrhythmias following a myocardial infarction. Many patients with stable ST‐segment–elevation myocardial infarction (STEMI) are still routinely triaged to cardiac intensive care units after a primary percutaneous coronary intervention (pPCI), independent of clinical risk or the provision of critical care therapies. The aim of this study was to determine factors associated with in‐hospital adverse events in a hemodynamically stable, postreperfusion population of patients with STEMI. METHODS AND RESULTS: Between April 2012 and November 2019, 2101 consecutive patients with STEMI who received pPCI in the Vancouver Coastal Health Authority were evaluated. Patients were stratified into those with and without subsequent adverse events, which were defined as cardiogenic shock, in‐hospital cardiac arrest, stroke, re‐infarction, and death. Multivariable logistic regression models were used to determine predictors of adverse events. After excluding patients presenting with cardiac arrest, cardiogenic shock, or heart failure, the final analysis cohort comprised 1770 stable patients with STEMI who had received pPCI. A total of 94 (5.3%) patients developed at least one adverse event: cardiogenic shock 55 (3.1%), in‐hospital cardiac arrest 42 (2.4%), death 28 (1.6%), stroke 21 (1.2%), and re‐infarction 5 (0.3%). Univariable predictors of adverse events were older age, female sex, prior stroke, chronic kidney disease, and atrial fibrillation. There was no significant difference in reperfusion times between those with and without adverse events. Following multivariable adjustment, moderate to severe chronic kidney disease (creatinine clearance <44 mL/min; 13% of cohort) was associated with adverse events (odds ratio 2.24 [95% CI, 1.12–4.48]) independent of reperfusion time, age, sex, smoking status, hypertension, diabetes, and prior myocardial infarction/PCI/coronary artery bypass grafting. CONCLUSIONS: Only 1 in 20 initially stable patients with STEMI receiving pPCI developed an in‐hospital adverse event. Moderate to severe chronic kidney disease independently predicted the risk of future adverse events. These results indicate that the majority of patients with STEMI who receive pPCI may not require routine admission to a cardiac intensive care unit following reperfusion.
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spelling pubmed-94964262022-09-30 Incidence and Predictors of Adverse Events Among Initially Stable ST‐Elevation Myocardial Infarction Patients Following Primary Percutaneous Coronary Intervention Amon, Jaihoon Wong, Graham C. Lee, Terry Singer, Joel Cairns, John Shavadia, Jay S. Granger, Christopher Gin, Kenneth Wang, Tracy Y. van Diepen, Sean Fordyce, Christopher B. J Am Heart Assoc Original Research BACKGROUND: Cardiac intensive care units were originally created in the prerevascularization era for the early recognition of ventricular arrhythmias following a myocardial infarction. Many patients with stable ST‐segment–elevation myocardial infarction (STEMI) are still routinely triaged to cardiac intensive care units after a primary percutaneous coronary intervention (pPCI), independent of clinical risk or the provision of critical care therapies. The aim of this study was to determine factors associated with in‐hospital adverse events in a hemodynamically stable, postreperfusion population of patients with STEMI. METHODS AND RESULTS: Between April 2012 and November 2019, 2101 consecutive patients with STEMI who received pPCI in the Vancouver Coastal Health Authority were evaluated. Patients were stratified into those with and without subsequent adverse events, which were defined as cardiogenic shock, in‐hospital cardiac arrest, stroke, re‐infarction, and death. Multivariable logistic regression models were used to determine predictors of adverse events. After excluding patients presenting with cardiac arrest, cardiogenic shock, or heart failure, the final analysis cohort comprised 1770 stable patients with STEMI who had received pPCI. A total of 94 (5.3%) patients developed at least one adverse event: cardiogenic shock 55 (3.1%), in‐hospital cardiac arrest 42 (2.4%), death 28 (1.6%), stroke 21 (1.2%), and re‐infarction 5 (0.3%). Univariable predictors of adverse events were older age, female sex, prior stroke, chronic kidney disease, and atrial fibrillation. There was no significant difference in reperfusion times between those with and without adverse events. Following multivariable adjustment, moderate to severe chronic kidney disease (creatinine clearance <44 mL/min; 13% of cohort) was associated with adverse events (odds ratio 2.24 [95% CI, 1.12–4.48]) independent of reperfusion time, age, sex, smoking status, hypertension, diabetes, and prior myocardial infarction/PCI/coronary artery bypass grafting. CONCLUSIONS: Only 1 in 20 initially stable patients with STEMI receiving pPCI developed an in‐hospital adverse event. Moderate to severe chronic kidney disease independently predicted the risk of future adverse events. These results indicate that the majority of patients with STEMI who receive pPCI may not require routine admission to a cardiac intensive care unit following reperfusion. John Wiley and Sons Inc. 2022-09-03 /pmc/articles/PMC9496426/ /pubmed/36056738 http://dx.doi.org/10.1161/JAHA.122.025572 Text en © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Amon, Jaihoon
Wong, Graham C.
Lee, Terry
Singer, Joel
Cairns, John
Shavadia, Jay S.
Granger, Christopher
Gin, Kenneth
Wang, Tracy Y.
van Diepen, Sean
Fordyce, Christopher B.
Incidence and Predictors of Adverse Events Among Initially Stable ST‐Elevation Myocardial Infarction Patients Following Primary Percutaneous Coronary Intervention
title Incidence and Predictors of Adverse Events Among Initially Stable ST‐Elevation Myocardial Infarction Patients Following Primary Percutaneous Coronary Intervention
title_full Incidence and Predictors of Adverse Events Among Initially Stable ST‐Elevation Myocardial Infarction Patients Following Primary Percutaneous Coronary Intervention
title_fullStr Incidence and Predictors of Adverse Events Among Initially Stable ST‐Elevation Myocardial Infarction Patients Following Primary Percutaneous Coronary Intervention
title_full_unstemmed Incidence and Predictors of Adverse Events Among Initially Stable ST‐Elevation Myocardial Infarction Patients Following Primary Percutaneous Coronary Intervention
title_short Incidence and Predictors of Adverse Events Among Initially Stable ST‐Elevation Myocardial Infarction Patients Following Primary Percutaneous Coronary Intervention
title_sort incidence and predictors of adverse events among initially stable st‐elevation myocardial infarction patients following primary percutaneous coronary intervention
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9496426/
https://www.ncbi.nlm.nih.gov/pubmed/36056738
http://dx.doi.org/10.1161/JAHA.122.025572
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