Belgrade University, Serbia
Title: Prognostic factors for hospital mortality in STEMI patients in Serbia
Zorana Vasiljevic-Pokrajcic has completed her Ph.D. at the age of 25 years from Belgrade University School of Medicine and Postdoctoral studies from Belgrade University School of Medicine. She was head Urgent Cardiology Department of Cardiology Clinic Medical Faculty, University of Belgrade, Clinical Centre Serbia 1998-2012. She is Full professor of Internal Medicine/Cardiology, Medical Faculty, University of Belgrade. She was former President of Cardiology Society of Serbia and Coronary Care Association of Serbia. She has published more than 250 papers in reputed journals, 635 citations of Scopus and has been serving as an editorial board member
It is well known that prognosis of ST-segment elevation myocardial infarction (STEMI) patients (pts) is time dependent on applying reperfusion therapy (RT), pPCI or fibrinolysis (FT), standard therapy, PCI centre network, possibility of medical and technical equipment, but also depending of pts age, comorbidity, risk factors and time from symptom onset to RT. There was no data from Serbia as a country in transition and country being under embargo during more than 10 years. In our observational, cross sectional study the data was used from the hospital registry for acute coronary syndrome (HORAKS); we analyzed 15354 consecutive STEMI pts from 2007. to 2009., mean age 63.6±12.0 years, m/f 65/35%. The RT was applied in 55.3% pts: pPCI in 21.9% pts aged 60.0±11.7, m/f 70.5/29.5 and FT in 33.4% pts aged 61.2±11.3, m/f 68.3/32.0. There were 44.6% non reperfused pts which were the oldest, mean age 67.1±11.6 (P) and with the most female with m/f 60.6/39.4. Overall STEMI hospital mortality was 11.8%; in pPCI group 6.2%, in FT group 10.5% and in nonreperfused pts 15.7%. Significant predictors of the fatal in-hospital outcome in reperfused patients were (HL, χ2=13.492, p=0.096, c statistic 0.876, SE 0.007, 95% CI 0.861-0.891) ages ≥75 years, the time from symptoms onset >360 minutes, anterior localization, Killip > I, especially cardiogenic shock, diabetes mellitus, previous stroke, treatment in non-PCI center and the lack of application of the p-PCI. Odds ratio (OR) higher than 2.0 were in variables: HF, age ≥75 years and lack of application of the p-PCI.
Conclusion: Estimated risk level of the patients was the most dependent of ages and comorbidities: heart failure, diabetes and stroke. The time from the symptom onset to arrival to the medical hospital is the important factor, but in Serbia the crucial factors are type of RT -pPCI end estimated risk level of pts.