Factors that impact in-hospital mortality due to STEMI versus NSTEMI in a first percutaneous coronary intervention: survival analysis

Miguel A. Medina-Pabón, Applied and Epidemiological Research Group, Auna Ideas, Medellín, Colombia
Nicolas Jaramillo, Department of Hemodynamics, Clínica las Américas Auna, Medellín, Colombia
Carlos F. Jaramillo, Department of Hemodynamics, Clínica las Américas Auna, Medellín, Colombia
Amalia Restrepo-Maya, Faculty of Medicine, CES University, Medellín, Colombia
Gabriela Prada-Zapata, Faculty of Medicine, CES University, Medellín, Colombia
José A. Muñoz-Rodríguez, Faculty of Medicine, CES University, Medellín, Colombia
Valentina Buscema-Gutiérrez, Faculty of Medicine, CES University, Medellín, Colombia
Juan C. Cuadros-Henao, Faculty of Medicine, CES University, Medellín, Colombia
Santiago Zuluaga-Rodas, Faculty of Medicine, CES University, Medellín, Colombia
Valentina López-Gómez, Faculty of Medicine, CES University, Medellín, Colombia
Alexis Llamas, Department of Cardiology, Clínica las Américas Auna, Medellín, Colombia

Objective: Acute coronary syndrome is a potentially fatal disease if it is not intervened in a timely and appropriate manner. In Colombia in 2021, 51,988 deaths were recorded from this cause. The aim is to compare the clinical characteristics of ST-elevation myocardial infarction (STEMI) and non-ST elevation acute myocardial infarction (NSTEMI) and percutaneous coronary intervention (PCI), determining in-hospital (< 30 days) survival with factors associated with mortality. Methods: Prospective cohort study (2020-2021), with survival analysis using the Kaplan–Meier method and Cox regression model to determine predictive factors that impacted in-hospital mortality in a high-complexity institution, Medellín, Colombia. Results: Of 504 participants, 53% had STEMI, and 47% had NSTEMI. Median age 64 years (interquartile range 57-73), 66% were men. In-hospital survival in NSTEMI was 98.3% (95% confidence interval [CI]: 97-100), and STEMI was 93.7% (95% CI: 91-97). Significant predictors that impacted in-hospital mortality for STEMI were: Age > 65 years (hazard ratio [HR]: 3.47 p: 042), Diabetes (HR: 5.07 p: 0.002), Killip IV (HR: 21.6 p < 0.001) and post-PCI Arrhythmia (HR: 6 p: 0.002). In contrast, predictors for NSTEMI were Cardiogenic Shock (HR: 23.3 p: 0.047) and post-PCI arrhythmia (HR: 23.4 p: 0.047). Conclusion: Patients with Killip IV NSTEMI and post-PCI arrhythmia constitute a group at higher cardiovascular risk with a higher in-hospital mortality than STEMI patients. Furthermore, diabetes is a modifiable risk factor that could impact early survival in STEMI patients after PCI.

Keywords: Myocardial infarction. ST elevation myocardial infarction. Non-ST-elevated myocardial infarction. Angioplasty balloon coronary. Percutaneous coronary intervention. Survival analysis.