Abstract 3011: Incidence and Predictors of Mortality Among Patients Undergoing Rescue Percutaneous Coronary Intervention after Failed Fibrinolysis for ST-Elevation Myocardial Infarction
BACKGROUND: Fibrinolytic therapy reduces mortality in eligible ST elevation myocardial infarction (STEMI) patients, yet up to 40 percent of those treated with fibrinolysis require rescue percutaneous coronary intervention (PCI) to treat ongoing myocardial ischemia that does not resolve with fibrinolysis alone. The mortality rate and its predictors among patients undergoing rescue PCI in routine practice have not been characterized.
METHODS: The study population consisted of all STEMI patients undergoing rescue PCI in the 484 hospitals contributing to the American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR) during the period 1/1/04 –3/31/06. In-hospital mortality was assessed in this cohort, and a multivariable logistic regression model with generalized estimating equation was used to determine the independent predictors of mortality. The c-statistic was used to assess model discrimination.
RESULTS: Among a total of 309,351 PCI procedures, 2417 STEMI patients underwent rescue PCI by a relatively restrictive definition; these patients were mostly male (1815/2417; 75%) and Caucasian (2133/2417; 88%), with a mean age (± standard deviation) of 59±12 years. In-hospital mortality occurred in 132 of 2417 patients (5.5%; 95% confidence interval, 4.6 – 6.4%). The independent predictors of in-hospital mortality are shown in the Table⇓. Mortality discrimination with this model was excellent (c = 0.92).
CONCLUSIONS: In-hospital mortality among patients undergoing rescue PCI exceeds 5%, and several readily-discernible clinical factors are associated with increased mortality in this population.