Risk Factors, Therapeutic Approaches, and In‐Hospital Outcomes in Mexicans With ST‐Elevation Acute Myocardial Infarction: The RENASICA II Multicenter Registry

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 Me...

Full description

Saved in:
Bibliographic Details
Published in:Clinical cardiology (Mahwah, N.J.) N.J.), 2013-05, Vol.36 (5), p.241-248
Main Authors: Juárez‐Herrera, Úrsulo, Jerjes‐Sánchez, Carlos
Format: Article
Language:English
Subjects:
Acute coronary syndromes
Adult
Age Factors
Aged
Aged, 80 and over
Anterior Wall Myocardial Infarction - diagnosis
Anterior Wall Myocardial Infarction - mortality
Anterior Wall Myocardial Infarction - therapy
Cardiovascular disease
Confidence intervals
Coronary Artery Bypass - adverse effects
Coronary Artery Bypass - mortality
Female
Heart attacks
Heart Block - mortality
Heart Block - therapy
Hospital Mortality
Hospitalization
Humans
Inferior Wall Myocardial Infarction - diagnosis
Inferior Wall Myocardial Infarction - mortality
Inferior Wall Myocardial Infarction - therapy
Logistic Models
Male
Mexico - epidemiology
Middle Aged
Mortality
Multivariate Analysis
Odds Ratio
Percutaneous Coronary Intervention - adverse effects
Percutaneous Coronary Intervention - mortality
Quality and Outcomes
Recurrence
Registries
Risk Factors
Shock, Cardiogenic - mortality
Shock, Cardiogenic - therapy
Stroke - mortality
Stroke - therapy
Thrombolytic Therapy - adverse effects
Thrombolytic Therapy - mortality
Time Factors
Treatment Outcome
Young Adult
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary: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 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.
ISSN:0160-9289
1932-8737
DOI:10.1002/clc.22107