Incidence and Predictors of Adverse Events Among Initially Stable ST-Elevation Myocardial Infarction Patients Following Primary Percutaneous Coronary Intervention.

Content Provider	Europe PMC
Author	Amon, Jaihoon Wong, Graham C. Lee, Terry Singer, Joel Cairns, John Shavadia, Jay S. Granger, Christopher Gin, Kenneth Wang, Tracy Y. van Diepen, Sean Fordyce, Christopher B.
Abstract	BackgroundCardiac intensive care units were originally created in the prerevascularization era for the early recognition of ventricular arrhythmias following a myocardial infarction. Many patients with stable ST‐segment–elevation myocardial infarction (STEMI) are still routinely triaged to cardiac intensive care units after a primary percutaneous coronary intervention (pPCI), independent of clinical risk or the provision of critical care therapies. The aim of this study was to determine factors associated with in‐hospital adverse events in a hemodynamically stable, postreperfusion population of patients with STEMI.Methods and ResultsBetween April 2012 and November 2019, 2101 consecutive patients with STEMI who received pPCI in the Vancouver Coastal Health Authority were evaluated. Patients were stratified into those with and without subsequent adverse events, which were defined as cardiogenic shock, in‐hospital cardiac arrest, stroke, re‐infarction, and death. Multivariable logistic regression models were used to determine predictors of adverse events. After excluding patients presenting with cardiac arrest, cardiogenic shock, or heart failure, the final analysis cohort comprised 1770 stable patients with STEMI who had received pPCI. A total of 94 (5.3%) patients developed at least one adverse event: cardiogenic shock 55 (3.1%), in‐hospital cardiac arrest 42 (2.4%), death 28 (1.6%), stroke 21 (1.2%), and re‐infarction 5 (0.3%). Univariable predictors of adverse events were older age, female sex, prior stroke, chronic kidney disease, and atrial fibrillation. There was no significant difference in reperfusion times between those with and without adverse events. Following multivariable adjustment, moderate to severe chronic kidney disease (creatinine clearance <44 mL/min; 13% of cohort) was associated with adverse events (odds ratio 2.24 [95% CI, 1.12–4.48]) independent of reperfusion time, age, sex, smoking status, hypertension, diabetes, and prior myocardial infarction/PCI/coronary artery bypass grafting.ConclusionsOnly 1 in 20 initially stable patients with STEMI receiving pPCI developed an in‐hospital adverse event. Moderate to severe chronic kidney disease independently predicted the risk of future adverse events. These results indicate that the majority of patients with STEMI who receive pPCI may not require routine admission to a cardiac intensive care unit following reperfusion.
Page Count	8
Journal	Journal of the American Heart Association
Volume Number	11
PubMed Central reference number	PMC9496426
Issue Number	17
PubMed reference number	36056738
e-ISSN	20479980
DOI	10.1161/jaha.122.025572
Language	English
Publisher	John Wiley and Sons Inc.
Publisher Date	2022-09-03
Publisher Place	Hoboken
Access Restriction	Open
Rights License	This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
Subject Keyword	creatine heart failure myocardial infarction percutaneous coronary intervention shock cardiogenic ST‐elevation myocardial infarction Percutaneous Coronary Intervention Revascularization Acute Coronary Syndromes Coronary Artery Disease
Content Type	Text
Resource Type	Article
Subject	Cardiology and Cardiovascular Medicine