Predictive Model of Hospital Mortality due to Myocardial Infarction in a Cohort of a Multicenter Registry

Authors

Keywords:

risk stratification, acute myocardial infarction, hospital mortality, predictive factors.

Abstract

Introduction: Multiple variables have an impact on in-hospital mortality after acute myocardial infarction.

Objective: To create a predictive model of in-hospital death due to acute myocardial infarction.

Methods: An analytical cohort-type, multicenter study was performed in patients with acute myocardial infarction between January 1, 2018 and December 31, 2019. The universe was patients admitted and incorporated into the Cuban infarction registry database and 1124 the population that met the inclusion criteria. The chi-squared test or Fisher's exact test was used, as appropriate. For quantitative variables, the arithmetic mean with standard deviation was used. A binary logistic regression model was used where the dependent variable was status at discharge.

Results: 74.5% of the deceased were over 70 years of age. Systolic blood pressure less than 100 mmHg (OR 2.974, p = 0.001), age over 70 years (OR 3.594, p = 0.000), more than seven leads affected (OR 3.796, p = 0.000), high grade atrioventricular block (OR 4.305, p = 0.000), Killip Kimbal IV (OR 4.353, p = 0.002), the presence of ventricular fibrillation-ventricular tachycardia (OR 6.257, p = 0.000) and glomerular filtration rate less than 60 ml/min/1.73m2 (OR 15.237, p = 0.000) were the variables that were part of the predictive model, which presented very good discrimination (area under the curve 0.902) and calibration (0.483).

Conclusions: A predictive model of in-hospital mortality due to myocardial infarction was created with seven predictors. 

Downloads

Download data is not yet available.

Author Biography

Maikel Santos Medina, Hospital General Docente Dr.Ernesto Guevara

Jefe Servicio Provincial Cardiología. Las Tunas

References

Anderson JL, Morrow DA. Acute myocardial infarction. N Engl J Med. 2017;376(21):2053-64. DOI: https://doi.org/10.1056/NEJMra1606915

Nscimento BR, Caldeira LC, Marino BC, Passaglia LG, Ribeiro AL. Implementing myocardial infarction systems of care in low/middle-income countries. Heart. 2019;105:20-6. DOI: http://dx.doi.org/10.1136/heartjnl-2018-313398

Reed GW, Rossi JE, Cannon CP. Acute myocardial infarction. Lancet. 2017;389:197-210. DOI: http://dx.doi.org/10.1016/S0140-6736(16)30677-8

Scirica BM, Libby P, Morrow DA. Infarto de miocardio con elevación del ST: fisiopatología y evolución clínica. En: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, editores. Braunwald´s Heart disease. A textbook of cardiovacular medicine. 11na Edición. España: Elsevier España, S.L.U; 2019. p.1095-121

Ministerio de Salud Pública. Anuario Estadístico 2020. La Habana: MINSAP; 2021 [acceso 14/05/2020]. Disponible en: https://temas.sld.cu/estadisticassalud

Santos Medina M, Obregón Santos AG, Piriz Assa A, Gutiérrez Martínez AA. Estratificación de riesgo en pacientes con infarto agudo de miocardio utilizando escalas de riesgos. Necesidad de homogeneizarla en Cuba. Rev Cubana Cardiol Cir Cardiovasc. 2019 [acceso 14/05/2020];25(Supl). Disponible en: http://revcardiologia.sld.cu/index.php/revcardiologia/article/view/892

García de Castro AM, Narváez Mayorga I, Rodríguez Padial L. Protocolo sobre estratificación de riesgo en pacientes con síndrome coronario agudo. Medicine. 2017;12(37):2248-52. DOI: https://doi.org/10.1016/j.med.2017.06.024

Ruiz Nodar J, Abu-Assi E. Factores determinantes del riesgo isquémico del paciente tras un infarto agudo de miocardio. Rev Esp Cardiol. 2017;17(B):9-15. DOI: https://doi.org/10.1016/S1131-3587(19)30018-4

Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-77. DOI: https://doi.org/10.1093/eurheartj/ehx393

Fox KA, Langrish JP. Estratificación del riesgo en los síndromes coronarios agudos. Rev Esp Cardiol. 2010;63(6):629-32. DOI: https://doi.org/10.1016/S0300-8932(10)70153-6

Chan Pin Yin D, Azzahhfi J, James S. Risk assessment using risk score in patients with acute coronary syndrome. J. Clin. Med. 2020;9(9):30-9. DOI: https://doi.org/10.3390/jcm9093039

Santos Medina M, Rodríguez Ramos M, Prohias Martínez JA, Ochoa Montes LA, Dueñas Herrera A, De Lara Abad J. Bases metodológicas del registro cubano de infarto agudo del miocardio: de la utopía a la realidad. Rev Cubana Cardiol Cir Cardiovasc. 2018 [acceso 01/03/2020];24(2):4-10. Disponible en: http://revcardiologia.sld.cu/index.php/revcardiologia/article/view/741

Vila Baños R, Torrado Fonseca M, Reguant Álvarez M. Análisis de regresión lineal múltiple con SPSS: un ejemplo práctico. REIRE. 2019;12(2):1-10. DOI: https://doi.org/10.1344/reire2019.12. 222704

Sagaró del Campo NM, Zamora Matamoros L. Análisis estadístico implicativo versus regresión logística binaria para el estudio de la causalidad en salud. Multimed. 2019 [acceso 14/10/2021];23(6):1416-40. Disponible en: http://www.revmultimed.sld.cu/index.php/mtm/article/view/1435

Steyerberg EW, Van Calster B, Pencina MJ. Medidas del rendimiento de modelos de predicción y marcadores pronósticos: evaluación de las predicciones y clasificaciones. Rev Esp Cardiol. 2011;64(9):788–94. DOI: https://doi.org/10.1016/j.recesp.2011.04.017

Chandrashekhar Y, Alexander T, Mullasari A, Kumbhani DJ, Alam S, Alexanderson E, et al. Resourse and infrastructure appropriate management of ST-segment elevation myocardial infarction in low and middle-income countries. Circulation. 2020;141(5):2004-25. DOI: https://doi.org/10.1161/CIRCULATIONAHA.119.041297

Hsu J, Iversen T, Price M, Mogers TA, Tevis D, Hagen TP, et al. Myocardial infarction care among the elderly: declining treatment with increasing age in two countries. Health Aff. 2021;40(9):1483-90. DOI: https://doi.org/10.1377/hlthaff.2021.00108

Forman DE, Maurer MS, Boyd C, Brindis R, Salive ME, Mc Farland Horne F, et al. Multimorbidity in older adults with cardiovascular disease. JAAC. 2018; 71(19):2149-61. DOI: http://dx.doi.org/10.1016/j.jacc.2018.03.022

Mccullough PA. Interconexión entre la enfermedad renal y la enfermedad cardiovascular. En: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF. Braunwald. Tratado de Cardiología. Texto de medicina cardiovascular. 11na Edición. España: Elsevier España, S.L.U; 2019. p. 1910-28.

Thierer J. Síndrome cardiorrenal. Una revisión. Rev Urug Cardiol. 2018;33(1):8-27. DOI: http://dx.doi.org/10.29277/cardio.33.1.2

Bohula EA, Morrow DA. Infarto de miocardio con elevación del ST: tratamiento. En: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, editores. Braunwald´s Heart disease. A textbook of cardiovacular medicine. 11na Edición. España: Elsevier España, S.L.U; 2019. p.1123-72

Schmitz T, Thilo C, Linseisen J, Heier M, Peters A, Kuch B, et al. Admission ECG changes predict short term-mortality after acute myocardial infarction less reliable in patients with diabetes. Sci Rep. 2021;11(2):6307. DOI: http://doi.org/10.1038/s41598-021-85674-9

Kazemi B, Sadat Ebrahimi SR, Ranjibar A, Akbarzadeh F, Sadaie MR, Safaei N, et al. Clinical utility of aVR lead t-wave in electrocardiogram of patients with ST-elevation myocardial infarction. BMC Cardiovasc Disord. 2021;21:520. DOI: https://doi.org/10.1186/s12872-021-02335-5

González F, Arteaga MI, Lorena Jofre M, Valdebenito M, Pardo J. Importancia del electrocardiograma en el diagnóstico del infarto agudo al miocardio por obstrucción del tronco común de arteria coronaria izquierda. Rev Med Chile. 2020;148(10):1508-12. DOI: http://dx.doi.org/10.4067/S0034-98872020001001508

Takada T, Shishido K, Hayashi T, Yokota S, Miyashita H, Yokoyama H, et al. Impact of Late Ventricular Arrhythmias on Cardiac Mortality in Patients with Acute Myocardial Infarction. J Interv Cardiol. 2019;[aprox. 8p]. DOI: https://doi.org/10.1155/2019/5345178

Saito K, Kondo Y, Takahashi M, Kitahara H, Nakayama T, Fujimoto Y, et al. Factors that predict ventricular arrhytmias in the late phase after acute myocardial infarction. ESC Heart Fail. 2021;8(5):4152-60. DOI: https://doi.org/10.1002/ehf2.13499

Podolecki TS, Lenarczyk RK, Kowalczyk JP, Jedrzejczyk-Patej EK, Chodor PK, Mazurek MH, et al. Risk stratification for complex ventricular arrhythmia complicating ST-segment elevation myocardial infarction. Coron Artery Dis. 2018;29(8):681-6. DOI: https://doi.org/10.1097/MCA.0000000000000662

Samsky MD, Morrow DA, Proudfoot AG, Hochman JS, Thiele H, Rao SV, et al. Cardiogenic shock after acute myocardial infarction. JAMA. 2021;326(18):1840-50. DOI: https://doi.org/10.1001/jama.2021.18323

Published

2023-09-24

How to Cite

1.
Santos Medina M, Obregón Santos Ángel G, Piriz Assa AR, Rodríguez Ramos MA, Martínez García G, Vázquez Argote KR, et al. Predictive Model of Hospital Mortality due to Myocardial Infarction in a Cohort of a Multicenter Registry. Rev. cuba. cardiol. cir. cardiovasc. [Internet]. 2023 Sep. 24 [cited 2025 Mar. 9];29(3):e1283. Available from: https://revcardiologia.sld.cu/index.php/revcardiologia/article/view/1283

Issue

Section

Original Articles