Author/Editor		Sinkovič, Andreja; Koren, Metka
Title		Independent predictors of six-month mortality in patients with non-ST-elevation myocardial infarction (NSTEMI)
Type		članek
Source		Slov Kardiol
Vol. and No.		Letnik 5, št. 1
Publication year		2008
Volume		str. 4-8
Language		eng
Abstract		The incidence and prevalence of non-ST-elevation myocardial infarction (NSTEMI) is rising. In-hospital mortality of patients with ACS declined significantly in the last decade. In NSTEMI patients, in-hospital mortality declined from 2.9 % to 2.2 % and 6-month mortality from 4.9 % to 3.3 %. The most important well-known predictors of early and late mortality include the troponin level, admission heart failure and ECG changes. Early risk stratification making in diagnosis and treatment. Our aim was to evaluate early independent predictors of 6-month mortality in patients with NSTEMI. Methods. This observational prospective monocentric study included 100 patients with NSTEMI who were admitted to the Department of Medical Intensive Care. They had the chest pain, increased troponin T levels and either ST-segment depression >/- mV and/or T wave inversion >/- 0.1 mV and/or pathological Q wave suspicious of previous infarction. After initial medical therapy, percutaneous coronary intervations (PCI) were performed within the first 48 hours in the case of recurrent chest pain and/or rhytmic and/or hemodynamic instability. Results. 6-month mortality was 10 %. Between nonsurvivors and survivors at 6 month, significant differences were observed in physical activity, admission cholesterol levels, in-hospital cardiogenic shock, pulmonary edema and peak troponin T lvel. The most significant independent predictor of 6-month mortality by multivariate Cox regression was cardiogenic shock in-hospital (OR 0.019,95 % Cl 0.003 to 0.124, p < 0.001). Conclusions. In our patients with NSTEMI, the most significant independent predictor of 6-month mortality was in-hospital cardiogenic shock.
Summary		Izhodišče. Incidenca in prevalenca miokardnega infarkta brez dviga veznice ST (NSTEMI) se viša. Bolnišnična umrljivost bolnikov z akutnimi koronarnimi sindromi se je v zadnjem desetletju znižala. Pri bolnikih z NSTEMI se je bolnišnična umrljivost znižala od 2.9 % na 2.2 %, umrljivost v 6 mesecih pa od 4.9 % na 3.3 %. Med najpomembnejšimi dejavniki zgodnje in pozne umrljivostije vrednost serumskega troponina ter srčno popuščanje in EKG ob sprejemu. Zgodnja ocena tveganja je pomembna za zgodnje odločitve v diagnostiki in zdravljenju. Naš cilj je bila ocena zgodnjih neodvisnih napovednikov 6-mesečne umrljivosti pri naših bolnikih z NSTEMI. Metode. V našo monocentrično prospektivno opazovalno raziskavo smo vključili 100 bolnikov z NSTEMI, sprejetih na Oddelek za intenzivno interno medicino. Bolniki so imeli bolečine v prsih, povišan troponin T in znižanje ST >/- 0.1 mV in/ali negativni T >/- mV in/ali patološki Q značilen za predhodni infarkt srca. Po začetnem zdravljenju z zdravili, je bila opravljena perkutana koronarna intervencija (PCI) znotraj 48 ur v primeru ponavljajočih se bolečin in/ali aritmij in/ali hemodinamske nestabilnoisti. Rezultati. 6-mesečna umrljivost je bila 10 %. Med umrlimi in preživelimi so bile pomembne razlike v fizični aktivnosti, sprejemnih vrdnosti holesterola, kardiogenem šoku in pljučnem edemu ob sprejemu in najvišji vrednosti troponina T. Najpomembnejši neodvisni napovedni dejavnik 6-mesečne umrljivosti pa je bil kardiogeni šok kot dokazuje multivariantna statistična analiza (OR 0.019,95 %, Cl 0.003 to 0.124, p < 0.001). Zaključki. Pri naših bolnikih z NSTEMI je najpomembnejši neodvisni napovedni dejavnik 6-mesečne umrljivosti kardiogeni šok.
Descriptors		MYOCARDIAL INFARCTION SHOCK, CARDIOGENIC HOSPITAL MORTALITY HEART FAILURE, CONGESTIVE ELECTROCARDIOGRAPHY SURVIVAL RATE