@Article{Kruk2013,
journal="Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej",
issn="1734-9338",
volume="9",
number="3",
year="2013",
title="Original papersRisk is not flat. Comprehensive approach to multidimensional risk management in ST-elevation myocardial infarction treated with primary angioplasty (ANIN STEMI Registry)",
abstract=" 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.",
author="Kruk, Mariusz
and Przyłuski, Jakub
and Kalińczuk, Łukasz
and Pręgowski, Jerzy
and Kaczmarska, Edyta
and Petryka, Joanna
and Kępka, Cezary
and Bekta, Paweł
and Chmielak, Zbigniew
and Demkow, Marcin
and Ciszewski, Andrzej
and Karcz, Maciej
and Kłopotowski, Mariusz
and Witkowski, Adam
and Rużyłło, Witold",
pages="212--220",
doi="10.5114/pwki.2013.37498",
url="http://dx.doi.org/10.5114/pwki.2013.37498"
}