Key result
Age ≥65 linked to ~147% higher 30-day STEMI mortality alongside cardiogenic shock and Killip IV.
Observational (n=4,555)
Yes
Odds Ratio: 2.47 (95% CI 1.94–3.13)
In a Mexican STEMI registry, modifiable risk factors are highly prevalent, and short-term mortality is strongly predicted by advanced age, Killip class IV presentation, and cardiogenic shock.
May inform risk stratification in Mexican STEMI; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: Ischemic heart disease is a growing health problem in Latin America. We aimed to analyze risk factors, acute management, and short-term outcome of Mexicans with ST-elevation myocardial infarction (STEMI). HYPOTHESIS: Modifiable risk factors are associated with the occurrence of STEMI in Mexicans, and potentially preventable acute complications are responsible for most short-term deaths. METHODS: Among 8600 patients enrolled in Registro Nacional de los Síndromes Coronarios Agudos II (RENASICA II) with a suspected acute coronary syndrome, we analyzed 4555 patients (56%; age 21-100 y) with confirmed STEMI who presented within 24 hours from symptoms' onset. RESULTS: Smoking (66%), hypertension (50%), and diabetes (43%) were the main risk factors. Most patients (74%) presented with Killip class I (class IV in 4%). Anterior-located STEMI occurred in 56% of cases, and posterior-inferior in 40% of cases. Significant Q waves were present in 43%, right bundle branch block in 7%, left bundle branch block in 5%, first-degree atrioventricular block in 2%, and high-degree atrioventricular block in 2%. A total of 1685 (37%) patients received fibrinolytic therapy (streptokinase, 82%; alteplase, 17%; tenecteplase, 1%), with 31% of patients receiving therapy in <2 hours, 36% in 2-4 hours, 19% in 4-6 hours, and 15% in >6 hours. Thirty percent of patients received either percutaneous coronary intervention or coronary artery bypass grafting during hospitalization. Major adverse cardiovascular events were recurrent ischemia (12%), reinfarction (4%), cardiogenic shock (4%), and stroke (1%). The main predictors of 30-day mortality (10%) in multivariate analysis were age ≥65 years (odds ratio [OR]: 2.47, 95% confidence interval [CI]: 1.94-3.13), Killip class IV (OR: 10.60, 95% CI: 6.09-18.40), and cardiogenic shock (OR: 18.76, 95% CI: 10.60-33.20). CONCLUSIONS: Largely modifiable risk factors and preventable short-term complications are responsible for most STEMI cases and outcomes in this Mexican population.
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Juárez‐Herrera et al. (2013) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=4,555). Age ≥65 years vs. Age <65 years was evaluated on 30-day mortality (OR 2.47, 95% CI 1.94-3.13). In Mexican patients with STEMI, 30-day mortality was 10%, with age ≥65 years (OR 2.47), Killip class IV (OR 10.60), and cardiogenic shock (OR 18.76) identified as the main independent predictors.
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