MYOCARDIAL INFARCTION

CLINICAL PREDICTORS OF IN HOSPITAL COMPLICATIONS IN PATIENTS PRESENTING WITH ACUTE ST SEGMENT ELEVATION

Abstract

Objective: To determine clinical predictors of in-hospital complications in patients presenting with acute ST elevation myocardial infarction. Design: Descriptive Study. Period: from October 2010 to January 2011. Setting: Faisalabad Institute of Cardiology, Faisalabad.. Materials and methods: A total 342 patients with AMI were recruited in this study. All patients presenting with acute ST elevation myocardial infarction and fulfilling inclusion and exclusion criteria were included in the study. A full history was taken, particularly age, sex, occupation, address, history of smoking, diabetes mellitus, hypertension, ischemic heart disease and family history of ischemic heart disease. Primary end point was death while secondary end point were patients who had mechanical, ischemic or electrical complications or all of them. Results: Mean age of the study population was 56.3±12.7 years. There were 255(74.6%) males and 87(25.4%) females. There were 103(30.1%) diabetics, 137(40.1%) hypertensive and 174(50.9%) smokers. Family history of IHD was present in 34(9.9%). Obesity was observed in 60(17.5%). Dyslipidemia was observed in 45(13.2%). Majority of patients 123(36%) presented between 4-8 hours after the onset of symptoms. Only 72(21.1%) patients presented to the hospital within 4 hours of onset of symptoms. Overall 194(56.7%) patients had anterior wall myocardial infarction followed by Inferior wall myocardial infarction 84(24.6%) patients. Streptokinase therapy for thrombolysis was given to 236(69%) patients. Overall in-hospital mortality was 28(8.2%). Most frequent in-hospital complication was cardiogenic shock occurring in 38(11.1%) followed by Ischemic complications (Post MI angina and Re-MI) 37(10.8%), heart failure in 37(10.8%) and 1st and 2nd degree AV blocks in 36(10.5%) patients. In-hospital mortality was most significantly associated with site of MI i.e. anterior wall myocardial infarction (X2=28.88, p=0.0001) followed by patients not receiving Streptokinase therapy (X2=18, p=0.001), Age (X2=10.13, p=0.006). Site of MI had the highest Contingency Coefficient value of 0.279 followed by Streptokinase therapy 0.195 and age 0.170. Conclusions: Cardiogenic shock was the most frequent complication. Major predictors of in-hospital mortality were anterior wall myocardial infarction, patients not receiving streptokinase therapy and old age.