Baseline Risk Stratification of Patients Older Than 75 Years With Infarction and Cardiogenic Shock Undergoing Primary Angioplasty
Por:
Hernandez, JMDLT, Brugaletta, S, Hospital, JAG, Baz, JA, de Prado, AP, Palop, RL, Cid, B, Camarero, TG, Diego, A, Gutierrez, H, Diaz, JAF, Sanchis, J, Alfonso, F, Blanco, R, Botas, J, Cuartero, JN, Moreu, J, Bosa, F, Valle, JMV, Elizaga, J, Arrebola, AL, Arroyo, JRR, Hernandez, F, Salvatella, N, Monteagudo, M, Jaume, AG, Carrillo, X, Reyes, RM, Lozano, F, Rumoroso, JR, Andraka, L and Dominguez, AJ
Publicada:
1 dic 2019
Categoría:
Cardiology and cardiovascular medicine
Resumen:
Background and objectives: Patients older than 75 years with ST-segment elevation myocardial infarction undergoing primary angioplasty in cardiogenic shock have high mortality. Identification of preprocedural predictors of short- and long-term mortality could be useful to guide decision-making and further interventions.
Methods: We analyzed a nationwide registry of primary angioplasty in the elderly (ESTROFA MI + 75) comprising 3576 patients. The characteristics and outcomes of the subgroup of patients in cardiogenic shock were analyzed to identify associated factors and prognostic predictors in order to derive a baseline risk prediction score for 1-year mortality. The score was validated in an independent cohort.
Results: A total of 332 patients were included. Baseline independent predictors of mortality were anterior myocardial infarction (HR 2.8, 95%CI, 1.4-6.0 P= .005), ejection fraction < 40% (HR 2.3, 95%CI, 1.14-4.50 P = .018), and time from symptom onset to angioplasty > 6 hours (HR 3.2, 95%CI, 1.6-7.5; P= .001). A score was designed that included these predictive factors (score "6-ANT-40"). Survival at 1 year was 54.5% for patients with score 0, 32.3% for score 1, 27.4% for score 2 and 17% for score 3 (P = .004, c-statistic 0.70). The score was validated in an independent cohort of 124 patients, showing 1-year survival rates of 64.5%, 40.0%, 28.9%, and 22.2%, respectively (P = .008, c-statistic 0.68).
Conclusion: A preprocedural score based on 3 simple clinical variables (anterior location, ejection fraction < 40%, and delay time > 6 hours) may be used to estimate survival after primary angioplasty in elderly patients with cardiogenic shock and to guide preinterventional decision-making. (C) 2018 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.
Filiaciones:
Hernandez, JMDLT:
Hosp Univ Marques Valdecilla, Serv Cardiol, Unidad Cardiol Intervencionista, Santander, Spain
Brugaletta, S:
Hosp Clin Barcelona, Serv Cardiol, Unidad Cardiol Intervencionista, Barcelona, Spain
Hospital, JAG:
Hosp Bellvitge Princeps Espanya, Serv Cardiol, Unidad Cardiol Intervencionista, Barcelona, Spain
Baz, JA:
Hosp Vigo, Serv Cardiol, Unidad Cardiol Intervencionista, Vigo, Spain
de Prado, AP:
Hosp Leon, Serv Cardiol, Unidad Cardiol Intervencionista, Leon, Spain
Palop, RL:
Hosp San Juan, Serv Cardiol, Unidad Cardiol Intervencionista, Alicante, Spain
Cid, B:
Hosp Santiago De Compostela, Serv Cardiol, Unidad Cardiol Intervencionista, Santiago De Compostela, A Coruna, Spain
Camarero, TG:
Hosp Univ Marques Valdecilla, Serv Cardiol, Unidad Cardiol Intervencionista, Santander, Spain
Diego, A:
Hosp Clin Salamanca, Serv Cardiol, Unidad Cardiol Intervencionista, Salamanca, Spain
Gutierrez, H:
Hosp Clin Valladolid, Serv Cardiol, Unidad Cardiol Intervencionista, Valladolid, Spain
Diaz, JAF:
Hosp Puerta Hierro, Serv Cardiol, Unidad Cardiol Intervencionista, Madrid, Spain
Sanchis, J:
Hosp Clin Valencia, Serv Cardiol, Unidad Cardiol Intervencionista, Valencia, Spain
Alfonso, F:
Hosp Princesa, Serv Cardiol, Unidad Cardiol Intervencionista, Madrid, Spain
Blanco, R:
Hosp Cruces, Serv Cardiol, Unidad Cardiol Intervencionista, Bilbao, Spain
Botas, J:
Hosp Alcorcon, Serv Cardiol, Unidad Cardiol Intervencionista, Alcorcon, Spain
Cuartero, JN:
Hosp Albacete, Serv Cardiol, Unidad Cardiol Intervencionista, Albacete, Spain
Moreu, J:
Hosp Virgen Salud, Serv Cardiol, Unidad Cardiol Intervencionista, Toledo, Spain
Bosa, F:
Hosp Clin Tenerife, Serv Cardiol, Unidad Cardiol Intervencionista, Santa Cruz De Tenerife, Spain
Valle, JMV:
Hosp Cabuenes, Serv Cardiol, Unidad Cardiol Intervencionista, Gijon, Spain
Elizaga, J:
Hosp Gregorio Maranon, Serv Cardiol, Unidad Cardiol Intervencionista, Madrid, Spain
Arrebola, AL:
Hosp Virgen Nieves, Serv Cardiol, Unidad Cardiol Intervencionista, Granada, Spain
Arroyo, JRR:
Hosp Clin Zaragoza, Serv Cardiol, Unidad Cardiol Intervencionista, Zaragoza, Spain
Hernandez, F:
Hosp 12 Octubre, Serv Cardiol, Unidad Cardiol Intervencionista, Madrid, Spain
Salvatella, N:
Hosp del Mar, Inst Hosp Mar Invest Med IMIM, Grp Recerca Biomed Malalties Cor, Unidad Cardiol Intervencionista,Serv Cardiol, Barcelona, Spain
Monteagudo, M:
Hosp Doctor Peset, Serv Cardiol, Unidad Cardiol Intervencionista, Valencia, Spain
Jaume, AG:
Hosp Son Espases, Serv Cardiol, Unidad Cardiol Intervencionista, Palma de Mallorca, Spain
:
Hosp Badalona Germans Trias & Pujol, Serv Cardiol, Unidad Cardiol Intervencionista, Barcelona, Spain
Reyes, RM:
Fdn Jimenez Diaz, Serv Cardiol, Unidad Cardiol Intervencionista, Madrid, Spain
Lozano, F:
Hosp Ciudad Real, Serv Cardiol, Unidad Cardiol Intervencionista, Ciudad Real, Spain
Rumoroso, JR:
Hosp Galdacano, Serv Cardiol, Unidad Cardiol Intervencionista, Bilbao, Spain
Andraka, L:
Hosp Basurto, Serv Cardiol, Unidad Cardiol Intervencionista, Bilbao, Spain
Dominguez, AJ:
Hosp Virgen Victoria, Serv Cardiol, Unidad Cardiol Intervencionista, Malaga, Spain
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