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- Title
Predictors of Hospital Mortality in Patients with Acute Coronary Syndrome Complicated by Cardiogenic Shock.
- Authors
Szabó, Gábor Tamás; Ágoston, András; Csató, Gábor; Rácz, Ildikó; Bárány, Tamás; Uzonyi, Gábor; Szokol, Miklós; Sármán, Balázs; Jebelovszki, Éva; Édes, István Ferenc; Czuriga, Dániel; Kolozsvári, Rudolf; Csanádi, Zoltán; Édes, István; Kőszegi, Zsolt; Brugts, Jasper J.; Theuns, Dominic A.M.J.; Radhoe, Sumant P.; Veenis, Jesse F.
- Abstract
As demonstrated by earlier studies, pre-hospital triage with trans-telephonic electrocardiogram (TTECG) and direct referral for catheter therapy shows great value in the management of out-of-hospital chest pain emergencies. It does not only improve in-hospital mortality in ST-segment elevation myocardial infarction, but it has also been identified as an independent predictor of higher in-hospital survival rate. Since TTECG-facilitated triage shortens both transport time and percutaneous coronary intervention (PCI)-related procedural time intervals, it was hypothesized that even high-risk patients with acute coronary syndrome (ACS) and cardiogenic shock (CS) might also benefit from TTECG-based triage. Here, we decided to examine our database for new triage- and left ventricular (LV) function-related parameters that can influence in-hospital mortality in ACS complicated by CS. ACS patients were divided into two groups, namely, (1) hospital death patients (n = 77), and (2) hospital survivors (control, n = 210). Interestingly, TTECG-based consultation and triage of CS and ACS patients were confirmed as significant independent predictors of lower hospital mortality risk (odds ratio (OR) 0.40, confidence interval (CI) 0.21–0.76, p = 0.0049). Regarding LV function and blood chemistry, a good myocardial reperfusion after PCI (high area at risk (AAR) blush score/AAR LV segment number; OR 0.85, CI 0.78–0.98, p = 0.0178) and high glomerular filtration rate (GFR) value at the time of hospital admission (OR 0.97, CI 0.96–0.99, p = 0.0042) were the most crucial independent predictors of a decreased risk of in-hospital mortality in this model. At the same time, a prolonged time interval between symptom onset and hospital admission, successful resuscitation, and higher peak creatine kinase activity were the most important independent predictors for an increased risk of in-hospital mortality. In ACS patients with CS, (1) an early TTECG-based teleconsultation and triage, as well as (2) good myocardial perfusion after PCI and a high GFR value at the time of hospital admission, appear as major independent predictors of a lower in-hospital mortality rate.
- Subjects
HOSPITAL mortality; ACUTE coronary syndrome; INTRA-aortic balloon counterpulsation; CARDIOGENIC shock; HOSPITAL patients; PERCUTANEOUS coronary intervention; MYOCARDIAL reperfusion
- Publication
Sensors (14248220), 2021, Vol 21, Issue 3, p969
- ISSN
1424-8220
- Publication type
Article
- DOI
10.3390/s21030969