Factors affecting in-hospital mortality in acute ST-elevation myocardial infarction at the Philippine Heart Center.

Background: Studies on Filipinos with STEMI are limited. This study aims to comprehensively describe the clinical and biochemical profile, treatment strategies, clinical outcomes and predictors of in-hospital mortality among patients with STEMI admitted at the Philippine Heart Center.

Methods: A retrospective analysis was done on all patients with STEMI from September 1, 2018 to December 31, 2018. Factors associated with in-hospital mortality were determined using binary logistic regression analysis.

Results: There were 187 consecutive patients with STEMI included in this study. The mean age was 57.3 + 21.5 years with a male predominance (77%, 144). Primary percutaneous coronary intervention was done in 63.1% (n=118) of the patients who presented in our emergency room with time from symptom onset of <12 hours duration and with persistent ST-segment elevation on the electrocardiogram. The median time from onset of chest pain to first medical contact in our cohort was 7 hours, with a range of 4 to 24 hours. The door-to-balloon time was 46.2 + 22.8 minutes and the wire crossing time was 49.2 + 27.6 minutes. The left anterior descending artery was the most common culprit artery (120, 64.2%), followed by the right coronary artery (51, 27.3%) and left circumflex artery (16, 8.6%). PCI of the infarct-related artery (IRA) only was done in 71 patients (60.2%). Staged PCI of the non-infarct related artery was performed in 32 patients (27.1%) Complete revascularization at the time of primary PCI was done in 15 patients (12.7%). Forty-four patients (23.5%) underwent diagnostic angiography without intervention. Twenty-five patients (13.4%) presented to our emergency room more than 12 hours from the time of index chest pain and underwent routine primary PCI. After adjusting for all variables, factors associated with mortality include age (OR 1.3129, CI 1.0243-1.6827, p=0.032), alanine aminotransferase (ALT) level (OR 1.0208, CI 1.0035-1.0385, p=0.018) and ejection fraction (OR 0.86, CI 0.7500-0.9945, p=0.042).

Conclusion: Patients who underwent primary PCI within 12 hours from the onset of chest pain had significantly better outcomes. Age and baseline ALT level were strong predictors of mortality, while ejection fraction was a significant predictor of survival.