Prediction factors of in-hospital mortality in NSTEMI

Abstract

Background. Despite remarkable progress in recent decades in the management of patients with non-ST-segment elevation myocardial infarction (NSTEMI), the in-hospital mortality rate remains high. This depends on a number of factors: demographic, anthropometric, temporal, socio-economic, ethnic and others. Thus, the detection of an algorithm of factors with predictive value on the risk of in-hospital mortality is announced as an important milestone in the context of their appropriate management. The aim of the study was to evaluate prognostic factors associated with in-hospital death in patients with NSTEMI revascularized by percutaneous coronary intervention with stenting (PCI). Methods. An observational study was conducted in the period 2020-2023. 550 patients with NSTEMI revascularized by PCI have been included. Based on clinical and paraclinical records from admission (demographic data, cardiovascular risk factors, history of cardiovascular disease, comorbidities, clinical presentation, Killip class, laboratory results, electrocardiogram, echocardiogram selected from the 180 points questionnaire) plausible predictors of mortality were assessed in the context of comparative estimation of 2 groups: the first group -those who died (n=23; 4.18%) and the second group - patients who survived (n=527, 95.82%).Results. The age of the deceased patients was 71.39±2.05 years vs 66.24±0.45 years, p<0.05, compared to those who survived. The first group presented with an advanced degree (Killip class III and IV) of heart failure (14 (60.8%) vs 56 (10.6%), p<0.001) and the heart rate (HR) was 92.36± 4.77 vs 79.71±0.83 beats/min, p<0.05 of survivors. NT proBNP values in the deceased were 14127.85±3953.53 ng/mL vs 3869.08±412.26 ng/mL, p<0.05, the erythrocyte sedimentation rate (ESR) was 31.09±4.08 vs 20, 59±0.70 mm/h, p<0.05, creatinine was 133.0±10.23 µmol/L vs 106.85±2.71 µmol/L, p<0.05 and urea was 16.00±2.77 mmol/L vs 8.12±0.20 mmol/L, p<0.05. In the deceased group, the neutrophil-to- lymphocyte ratio, one of the factors which reflects the state of systemic inflammation, was 6,607±0,099 vs 3.254±0.084, p<0.01, in the survivors. The GRACE score reached higher values in the deceased group (148.3±5.2 vs 121.9±1.2; p<0.001).Conclusions. The rate of NSTEMI patients who died in hospital remains high in Republic of Moldova (4.18%) compared to the one reported in the European multicenter registry (1.0-2.8%). According to the obtained data, the risk factors that negatively influence the prognosis of NSTEMI patients revascularized by PCI are: age older than >71 years, HR over 90 beats/min, advanced heart failure, increased values of NTproBNP, elevated creatinine, GRACE Score over 143 points, neutrophil-lymphocyte ratio over 6.607, as well as the presence of comorbidities such as chronic obstructive pulmonary disease (COPD).