In-hospital mortality in patients with ST-segment elevation acute coronary syndrome and the relative risk of death considering life threatening signs occurring before, during, and after mechanical reperfusion

Objective . To evaluate in-hospital mortality in patients with ST-segment elevation acute coronary syndrome (ST-ACS) in comparison with the relative risk of death determined taking into account different stages of acute heart failure (AHF) and life-threatening signs that occurred before, during, and after primary percutaneous coronary interventions (PCI). Material and methods . The study included 239 patients with ST-ACS hospitalized at the Sklifosovsky Russian Central Research Institute for Emergency Medicine from July 1, 2024, to December 31, 2024. The age ranged from 29 to 99 years. Coronary angiography (CAG) was performed in 239 patients, primary PCI – in 233. Life-threatening decrease in blood pressure <100 mmHg was taken into account. Art., heart rate <50 bpm, ventricular fibrillation (VF), various stages of acute heart failure, and other unfavorable factors. The group with life-threatening signs preceding the interventions included 54 patients; 51 with signs occurring during and after PCI, and 128 without signs. The relative risk of death was determined taking into account life-threatening signs before and after PCI. Results . Of the 54 patients with life-threatening signs preceding PCI, 15 (6.4 %) died, 6 with cardiogenic shock (CABG), 9 with alveolar pulmonary edema, in all cases with a decrease in blood pressure <100 mmHg that persisted after the procedure. The relative risk of death taking into account blood pressure <100 mmHg, heart rate <50 bpm. and VF before PCI was 10.7, 3.7 and 3.7; taking into account CABG and alveolar pulmonary edema – 12.8 and 6.3. Of the 51 patients with life-threatening symptoms that developed during and after PCI, 7 died, including 1 with alveolar pulmonary edema, the remaining 6 with venous congestion, in all cases with progression of AHF and development into multiorgan failure. The relative risk of death taking into account BP <100 mmHg and VF during and after PCI was 3.6 and 7.3. According to the section data, in most of the deceased, the infarction-related artery (IA) was the anterior descending artery (LDA) in three-vessel disease with an extensive area of myocardial infarction (MI). In-hospital mortality among patients with STE-ACS was 10 %, including 9.7 % with PCI and 33 % without PCI. No differences were observed for PCI performed in the first 6, 6–12, and 12–72 hours, but age-related differences were significant. Among individuals aged 65, 65–75, and over 75, in-hospital mortality was 5.6 %, 8.9 %, and 20.7 %. The relative risks of death, taking into account three-vessel disease, LAD ISA, and age over 75, were 8.43, 4.39, and 3.24. These data suggest that despite the high relative risk of death, mortality associated with CABG was minimal, with the remainder occurring due to PCI with an unfavorable outcome in three-vessel disease, which is more common in older age groups.