Predictors of In-hospital mortality in Thai STEMI patients: Results from TACSR

Abstract

Background: Clinical predictors of high-risk STEMI patients may guide physicians to the type of treatment, as high-risk patients need more aggressive treatment than low-risk patients. There was no previous registry of STEMI patients in Thailand. Objective: To determine the clinical predictors of in-hospital mortality in STEMI patients from the Thai ACS Registry. Material and Method: A multi-center prospective nationwide Thai Acute Coronary Syndrome Registry (TACSR) was done between August 1, 2002 and October 31, 2005. The STEMI patients were registered to Thai ACS web site. Clinical and demographic characteristics, coronary risk factors, presenting symptoms, in-hospital treatments, reperfusion procedures and the patients' outcomes were recorded and analyzed. Results: 3,836 STEMI patients were studied. The mean age was 62.2 ± 12.8 years and 68% of the patients were male. The mortality rate of Thai STEMI patients was 17% (86.8% from cardiac causes) and the main cause of death was pumping failure (61.3%). The patients with older age ≥ 75 years, patients with diabetes, shock, and cardiac arrhythmias had a higher mortality (29.4, 21.2, 43.4 and 37.24% respectively), while patients who underwent primary percutaneous coronary intervention (primary PCI) had a lower mortality rate (12.66%). Patients who received treatment with ASA, beta-blocker, ACE inhibitor/ ARB and statin had lower in-hospital mortality. Conclusion: The clinical predictors of high in-hospital mortality in STEMI patients from the TACSR were older age ≥ 75 years, diabetes, shock, and cardiac arrhythmias. The treatments that can decrease the mortality were primary PCI, ASA, beta-blocker, ACE inhibitor/ARB and statin.