Hospital mortality trend analysis of patients with ST elevation myocardial infarction in the Belgrade area coronary care units
Authors: Vasiljevic Zorana , Stojanovic Bojan , Kocev Nikola , Stefanovic Branislav , Mrdovic Igor , Ostojic Miodrag , Krotin Mirjana , Putnikovic Biljana , Dimkovic Sinisa , Despotovic Nebojsa , Celic Vera , Karanovic Nevena , Mickovski-Katalina Natasa , Vojvodic Ana , Dimitrijevic Milan 
Published: August 2015

INTRODUCTION. Mortality in ST elevation myocardial infarction (STEMI) ranges
from 4-24% and is dependent on the variety of patients? clinical
characteristics (CC) that are present prior to and within the first hours of
the onset of MI, affecting reliability of the diagnosis. The higher mortality
rate of patients with STEMI should be associated with a higher rate of
applied reperfusion therapy according to guidelines and randomized study
results, which is in opposition to everyday hospital practice. OBJECTIVE. The
aim of this study was to analyze the mortality of STEMI patients in
relationship to their clinical characteristics at presentation, their age,
sex, risk factors, prior coronary disease, and time interval from symptom
onset to hospital presentation, complications and administered therapy.
METHOD. The analysis involved patients treated in five coronary care units,
four Belgrade Hospital Centres and the Belgrade Emergency Centre of the
Clinical Centre of Serbia. Evaluated data was obtained from the Serbian
National Registry for Acute Coronary Syndrome (REAKSS) and databases of local
coronary care units (CCU). RESULTS. During 2005 and 2006, a total of 2739
patients with STEMI, of average age 63.3?11.7, with 64.9% males aged
61.3?11.7 and 35.1% females aged 67.0?10.7 (p<0.01) who underwent treatment.
Most of the patients (80.5%) were distributed within the elderly groups of
60, 70 and 80 years of age, with the highest percent of mortality rate
(45.9%) noted at age 80 years. Anterior localization of myocardial infarction
was observed in 40.2% of patients, with lethal outcome in 21.4% patients,
while 59.8% of patients suffered inferiorly localized MI with much lower
mortality rate (12.2%, p<0.01). In 2005, STEMI was registered in 48.7%, while
in 2006 in 44.7% of patients. Prior angina pectoris was present in 19.9% of
patients, more frequently among women (p<0.05), prior MI in 14.5% of
patients, more often among males (p<0.05), while aortocoronary
revascularization was found in 3.9% of patients. Hospital mortality rate due
to STEMI was higher in the group of patients with a history of prior MI
(19.1% vs. 15.7%; p>0.05). Regarding risk factors, hypertension was present
in 61.8% of patients, more often among women (69.1% vs.57.9%) (p<0.01),
carrying a higher mortality rate of 18.9% vs. 9.9% among males (p<0.01).
Hyperlipidemia was found in 31.9% of patients; more frequently among women
34.8% vs. 30.4% males (p<0.05), as well as diabetes mellitus observed in
25.1% of patients; 22.4 % males and 30.1% females (p<0.01). 39.6% of patients
were smokers; 46.9% males and 28.0% females (p<0.01). Heart failure had 33.4%
of patients; mortality rate was registered in 28.2% of patients, and was
significantly higher than in the non heart failure group (7.9%, p<0.01).
Heart rhythm disorders were registered in 21.3% of patients, more frequently
involving posterior MI 55.3% vs 44.7% of anterior MI (p>0.05), and was
significantly higher among females 23.5% vs. 20.1% in males (p<0.05). In 2005
in Belgrade hospitals, reperfusion therapy (RT) was performed in 34.6% of
patients, mostly as thrombolytic therapy (TT) (in 99.0% of patients), and as
percutaneous coronary intervention (PCI) in 1.0% of patients. STEMI mortality
rate was 12.8%. In 2006, in the CCU of the In the Emergency Center RT was
applied in 48.0% of patients, TT in 13.8% and PCI in 34.2%, while classical
therapy without RT was applied in 52.0% of patients. CONCLUSION. Clinical
characteristics significantly influence mortality in STEMI; a significantly
higher mortality is among women, patients in their 80?s and 90?s, anterior MI
localization and prior coronary disease. RT significantly lowers mortality in
STEMI compared to the use of classical therapeutic approach and therefore
STEMI patients with a higher mortality determined by their prehospital
charactheristics, i.e. higher risk, are those who have higher benefit of RT,
which should be taken into consideration when making decision about the
therapy of choice.