Prognostic Impact of Organ Damage in STEMI Patients
Condition: Myocardial Infarction; Death; Acute Kidney Injury; Hepatic Insufficiency
MeSH terms: Hepatic Insufficiency; Liver Failure; Acute Kidney Injury; Myocardial Infarction; Infarction
Study type: Observational [Patient Registry]

Summary: 
      Besides contrast-induced acute kidney injury (CI-AKI), adscititious vital organ damage such
      as hypoxic liver injury (HLI) may affect the survival in patients with ST-elevation
      myocardial infarction (STEMI). Therefore, the investigator sought to evaluate the prognostic
      impact of CI-AKI and HLI in STEMI patients who underwent primary percutaneous coronary
      intervention (PCI).
    

Detailed description: 
      A total of 668 consecutive patients (77.2% male, mean age 61.3±13.3 years) with STEMI
      underwent primary PCI were analyzed. Hypertension was defined as systolic blood pressure ≥140
      mmHg and/or diastolic blood pressure ≥90 mmHg, or by antihypertensive prescription. Type 2
      diabetes was defined by hypoglycemic agents or insulin prescription, fasting plasma glucose
      ≥126 mg/dL, glycosylated hemoglobin (HbA1c) ≥6.5%, or known but untreated hyperglycemia.
      Dyslipidemia was defined by total cholesterol ≥240 mg/dL, LDL cholesterol ≥130 mg/dL, HDL
      cholesterol<40 mg/dL, triglycerides ≥200 mg/dL, and/or by lipid-lowering prescription.STEMI
      was defined as typical chest pain lasting for >30 min within the last 24h, with
      electrocardiographic findings of ST elevation >1 mm in at least two consecutive leads or
      new-onset left bundle branch block, and 2-fold elevation of serum levels of troponin-I or the
      creatine kinase-MB above the upper normal limit. Obstructive CAD was defined as ≥50% luminal
      narrowing and the extent of obstructive CAD was categorized according to the number of
      vessels involved (1, 2, or 3). CI-AKI was defined as increase in serum creatinine of ≥0.5
      mg/dl or 25% relative rise, within 48h after index procedure. HLI was defined as ≥2-fold
      increase of serum aspartate transaminase above upper normal limit at admission. Patients were
      divided into four groups according to their CI-AKI and HLI states. Major adverse
      cardiovascular and cerebrovascular events (MACCE) defined as composite of all-cause
      mortality, non-fatal MI, non-fatal stroke, ischemia-driven target lesion revascularization
      and target vessel revascularization were recorded. Continuous data were expressed as a mean
      value ± standard deviation or median value (interquartile range) as appropriate. Categorical
      data were presented as a percentage or absolute number. Analyses of continuous data were
      performed using analysis of variance (ANOVA) test or Kruskal-Wallis test as appropriate and
      analyses of categorical data were performed using chi-square test to assess differences among
      the four groups. Cumulative event rates as a function over time were estimated using the
      Kaplan-Meier method.
    

Observational model: Cohort
Sampling method: Non-Probability Sample
Study population: 
        A total of 668 STEMI patients (77.2% male, mean age 61.3±13.3 years) with STEMI underwent
        primary PCI between 2007 and 2014 were enrolled. Primary PCI was performed according to
        standard clinical practice. Pharmacological therapy, temporary pacemaker insertion, and
        intra-aortic balloon pump support were left to the operators' discretion.