Predictors of hospital mortality based on primary angioplasty treatment

Abstract

Predictors of Hospital Mortality in Patients Undergoing Primary Angioplasty Introduction: Cardiovascular diseases (CVD) are the main cause of morbidity and mortality in Brazil. Ischemic heart disease is the cause of the highest number of deaths among CVDs. The primary angioplasty (PCI) consists of a mechanical treatment to reopen a blocked coronary artery related to acute myocardial infarction with ST-segment elevation. It´s the preferred treatment strategy since it can be performed promptly. Stratifying the risk of death of patients in this context is essential for decision-making and clinical research. Objectives: identify factors related to the outcome of death in patients undergoing PCI. Material and methods: Case-control study, using a national registry as a data source. This registry as a result of the voluntary collaboration of the members of the Brazilian society of hemodynamics and interventional cardiology called the National Cardiovascular Interventions Center (CENIC). The patients were divided into two groups, in the first (cases) the data on patients who died and in the second group (control), patients who underwent the procedure and who survived were allocated. The variables were selected based on previous studies. The association between each variable and the death outcome was assessed using a simple logistic regression model, variables with p <0.20 were included in multiple models using the stepwise strategy. The fit quality was assessed using the Hosmer-Lemeshow test. The results were presented as odds ratios (OR) with the respective 95% confidence intervals (95% CI). It was considered significant p <0.05. Results: 26,990 records were analyzed, of which 18,834 (69.8%) were male, with a mean age of 61.5 ± 12 years. The total number of deaths was 904 and the overall mortality rate was 3.3%. In the multivariate analysis, the main variables related to the death outcome were age> 60 years (60 to 69 years with OR 2,004 [1,336; 3,076], 70 to 79 years OR 2,462 [1,635; 3,789], and ≥ 80 years OR 3,688 [2,384; 5,812], Killip II, III and IV (II with OR 2,718 [1,919; 3,827], III OR 8,139 [5,672; 11,637] and IV OR 19,833 [14,851; 26,688]), severe ventricular dysfunction (OR 3,625 [2,393; 5,675]) and infarction after the intervention (OR 5.006 [2,568; 9,460]) were associated with a lower risk of death, male gender (OR 0.789 [0.635; 0.981]), dyslipidemia (OR 0.689 [0.558; 0.850]), TIMI 2 and 3 (2 with OR 0.593 [0.409; 0.857] and 3 OR) 0.176 [0.133; 0.235]) and the number of lesions treated (OR 0.859 [0.785; 0.938]). Conclusion: The predictors of mortality in patients undergoing PCI were: Killip classification, reinfarction, advanced age, severe global left ventricular dysfunction, female, and post-intervention TIMI 0 / I flow. The identification of these data can be useful in stratification and care for patients with coronary disease.