Causes of mortality and outcome in acute coronary syndrome.
Introduction: The study’s objective was to investigate the influence of various factors upon hospital mortality and the outcome of patients suffering from acute coronary syndrome (ACS) at a centre hosting a large proportion of complex patients.
Methods: All patients suffering from ACS (ST-segment-elevation myocardial infarction [STEMI], non-ST-elevation myocardial infarction [NSTEMI], and unstable angina pectoris [unstable AP]) and undergoing coronary angiography from January 2013 to June 2014 were included in the study. Analyses were carried out on overall hospital mortality and mortality differences between patients with and without cardiogenic shock, as well as patient groups undergoing various acute therapeutic measures, such as reanimation, catecholamine administration, intubation, and circulatory support systems.
Results: A total of 979 patients suffering from ACS were treated. Amongst them, 40.7% (n = 398) displayed STEMI, 49.9% (n = 489) NSTEMI, and 9.4% (n = 92) unstable AP. Overall hospital mortality was 6.7%, with STEMI patients displaying a mortality rate of 9.8%, NSTEMI patients 5.3%, and unstable AP patients 1.1%. Significantly higher mortality was observed amongst patients with cardiogenic shock (52.4%), or following reanimation (38.6%), catecholamine administration (28.3%), intubation (45.6%), or those requiring circulatory support (extracorporeal membrane oxygenation: 45.5%; intra-aortic balloon pump: 22.2%). On the other hand, patients exhibiting no cardiogenic shock at admission and that were neither reanimated, nor in need of catecholamine administration, intubation, or circulatory support systems displayed a considerably lower mortality rate ranging from 0.1% to 5.3%. The most common post-interventional causes of death following coronary angiography were hypoxic brain injury (33.3%) and refractory cardiogenic shock (30.3%). Only 0.3% (n = 3) of ACS patients died due to peri-interventional causes.
Conclusion: ACS patients displayed low overall mortality, which, however, was strongly dependent upon the clinical presentation of patients at admission and their hemodynamic status. Peri-interventional cases of death were very rare. In the future, research efforts should therefore focus particularly upon pre-hospital and in-hospital treatment of patients experiencing cardiogenic shock, and quality statistics should absolutely provide data adjusted for complexity.
Full article
