eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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vol. 9

Original papers
Risk is not flat. Comprehensive approach to multidimensional risk management in ST-elevation myocardial infarction treated with primary angioplasty (ANIN STEMI Registry)

Mariusz Kruk
Jakub Przyłuski
Łukasz Kalińczuk
Jerzy Pręgowski
Edyta Kaczmarska
Joanna Petryka
Cezary Kępka
Paweł Bekta
Zbigniew Chmielak
Marcin Demkow
Andrzej Ciszewski
Maciej Karcz
Mariusz Kłopotowski
Adam Witkowski
Witold Rużyłło

Postep Kardiol Inter 2013; 9, 3 (33): 212–220
Online publish date: 2013/09/16
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Introduction: Current risk assessment concepts in ST-elevation myocardial infarction (STEMI) are suboptimal for guiding clinical management.

Aim: To elaborate a composite risk management concept for STEMI, enhancing clinical decision making.

Material and methods: 1995 unselected, registry patients with STEMI treated with primary percutaneous coronary intervention (pPCI) (mean age 60.1 years, 72.1% men) were included in the study. The independent risk markers were grouped by means of factor analysis, and the appropriate hazards were identified.

Results: In-hospital death was the primary outcome, observed in 95 (4.7%) patients. Independent predictors of mortality included age, leukocytosis, hyperglycemia, tachycardia, low blood pressure, impaired renal function, Killip > 1, anemia, and history of coronary disease. The factor analysis identified two significant clusters of risk markers: 1. age-anemia- impaired renal function, interpreted as the patient-related hazard; and 2. tachycardia-Killip > 1-hyperglycemia-leukocytosis, interpreted as the event-related (hemodynamic) hazard. The hazard levels (from low to high) were defined based on the number of respective risk markers. Patient-related hazard determined outcomes most significantly within the low hemodynamic hazard group.

Conclusions: The dissection of the global risk into the combination of patient- and event-related (hemodynamic) hazards allows comprehensive assessment and management of several, often contradictory sources of risk in STEMI. The cohort of high-risk STEMI patients despite hemodynamically trivial infarction face the most suboptimal outcomes under the current invasive management strategy.

acute coronary syndrome, ST-elevation acute coronary syndrome, primary angioplasty, risk assessment

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