Background
Methods
Study population
Definition of variables and endpoint
Statistical analysis
Results
Baseline characteristics
All (n = 1057) | Mortality (−) (n = 982) | Mortality (+) (n = 75) | p value | |
---|---|---|---|---|
Demographic data | ||||
Age (years) | 60.5 ± 13.1 | 59.7 ± 12.9 | 70.8 ± 11.0 | < 0.001 |
Men [n (%)] | 837 (79.2) | 784 (79.8) | 53 (70.7) | 0.075 |
Body mass index (kg/m2) | 24.1 ± 3.2 | 24.2 ± 3.2 | 23.0 ± 3.6 | 0.002 |
Diabetes mellitus [n (%)] | 279 (26.4) | 250 (25.5) | 29 (38.7) | 0.020 |
Hypertension [n (%)] | 496 (46.9) | 452 (46.0) | 44 (58.7) | 0.041 |
Systolic blood pressure (mmHg) | 125.1 ± 27.3 | 126.3 ± 26.7 | 109.0 ± 30.8 | < 0.001 |
Diastolic blood pressure (mmHg) | 76.3 ± 17.5 | 77.0 ± 17.2 | 66.9 ± 19.2 | < 0.001 |
Heart rate (beats/minute) | 77.5 ± 20.1 | 76.7 ± 19.5 | 87.3 ± 25.0 | 0.001 |
Cardiogenic shock [n (%)] | 66 (6.2) | 47 (4.8) | 19 (25.3) | < 0.001 |
Killip class II–IV [n (%)] | 209 (19.8) | 168 (17.1) | 41 (54.7) | < 0.001 |
Anterior wall infarction [n (%)] | 564 (69.3) | 512 (52.1) | 52 (69.3) | 0.004 |
Laboratory data | ||||
Albumin (g/dL) | 4.2 ± 0.4 | 4.2 ± 0.4 | 3.8 ± 0.6 | < 0.001 |
Glucose (mg/dL) | 177.7 ± 83.1 | 173.0 ± 74.6 | 239.4 ± 144.0 | < 0.001 |
Dysglycemia [n (%)] | 159 (15.0) | 126(12.8) | 33 (44.0) | < 0.001 |
Total bilirubin (mg/dL) | 0.7 ± 0.4 | 0.7 ± 0.4 | 0.7 ± 0.5 | 0.245 |
AST (IU/L) | 33.0 (23.0–65.0) | 32.0 (23.0–61.0) | 72.0 (27.0–227.0) | < 0.001 |
ALT (IU/L) | 26.0 (19.0–42.0) | 26.0 (19.0–41.0) | 36.0 (18.0–78.0) | 0.034 |
Hypoxic liver injury† [n (%)] | 236 (22.3) | 199 (20.3) | 37 (49.3) | < 0.001 |
ALP (IU/L) | 74.0 (61.0–91.1) | 74.0 (61.0–90.0) | 81.0 (65.0–98.0) | 0.061 |
Creatinine (mg/dL) | 1.08 ± 0.73 | 1.06 ± 0.73 | 1.33 ± 0.67 | 0.001 |
Estimated GFR (mL/min/1.73 m2) | 82.1 ± 27.5 | 83.3 ± 26.8 | 65.8 ± 32.0 | < 0.001 |
Estimated GFR < 60 mL/min/1.73 m2 [n (%)] | 184 (17.4) | 152 (15.5) | 32 (42.7) | < 0.001 |
Hemoglobin (mg/dL) | 14.2 ± 1.9 | 14.3 ± 1.9 | 13.1 ± 2.4 | < 0.001 |
Anemia [n (%)] | 177 (16.7) | 146 (14.9) | 31 (41.3) | < 0.001 |
WBC (× 103/µL) | 12.0 ± 5.2 | 11.8 ± 5.2 | 13.9 ± 4.7 | 0.001 |
NLR | 3.1 (1.6–5.7) | 3.0 (1.5–5.4) | 5.4 (3.0–8.9) | < 0.001 |
NLR > 4.3 [n (%)] | 393 (37.2) | 342 (34.8) | 51 (68.0) | < 0.001 |
Total cholesterol (mg/dL) | 189.3 ± 43.7 | 190.6 ± 43.1 | 172.5 ± 47.8 | 0.001 |
LDL-cholesterol (mg/dL) | 117.0 ± 36.8 | 117.8 ± 36.7 | 106.6 ± 37.0 | 0.043 |
HDL-cholesterol (mg/dL) | 42.5 ± 11.0 | 42.6 ± 10.9 | 41.0 ± 11.7 | 0.305 |
Triglyceride | 129.0 (86.0–196.0) | 131.0 (87.0–197.0) | 111.0 (76.5–180.5) | 0.100 |
Initial CK-MB (ng/mL) | 5.3 (2.1–26.5) | 4.9 (2.1–22.5) | 26.0 (3.6–96.1) | < 0.001 |
Peak CK-MB (ng/mL) | 177.4 (78.2–300.0) | 170.9 (77.8–300.0) | 271.0 (86.0–332.2) | 0.016 |
All (n = 1057) | Mortality (−) (n = 982) | Mortality (+) (n = 75) | p value | |
---|---|---|---|---|
Angiographic and procedural data | ||||
Infarct related artery [n (%)] | NA | |||
Left main | 8 (0.8) | 2 (0.2) | 6 (8.0) | |
Left anterior descending | 556 (52.6) | 510 (51.9) | 46 (61.3) | |
Left circumflex | 95 (9.0) | 90 (9.2) | 5 (6.7) | |
Right coronary | 398 (37.7) | 380 (38.7) | 18 (24.0) | |
Extent of coronary artery disease [n (%)] | 0.257 | |||
1-vessel | 404 (38.2) | 382 (38.9) | 22 (29.3) | |
2-vessel | 364 (34.4) | 334 (34.0) | 30 (40.0) | |
3-vessel | 289 (27.3) | 266 (27.1) | 23 (30.7) | |
Baseline TIMI flow grade [n (%)] | 0.840 | |||
0–2 | 950 (90.0) | 884 (90.1) | 66 (89.2) | |
3 | 105 (10.0) | 97 (9.9) | 8 (10.8) | |
Final TIMI flow grade [n (%)] | < 0.001 | |||
0–2 | 163 (15.5) | 134 (13.7) | 29 (39.2) | |
3 | 892 (84.5) | 847 (86.3) | 45 (60.8) | |
Stent number (n) | 1.1 ± 0.3 | 1.1 ± 0.3 | 1.2 ± 0.5 | 0.036 |
Stent diameter (mm) | 3.09 ± 0.38 | 3.10 ± 0.38 | 2.95 ± 0.40 | 0.002 |
Stent length (mm) | 27.1 ± 10.5 | 26.8 ± 10.3 | 31.0 ± 13.3 | 0.012 |
Door-to-balloon time (min) | 72.0 (58.0–87.0) | 71.0 (58.0–87.0) | 80.0 (64.5–89.0) | 0.012 |
Symptom-to-balloon time (min) | 210.0 (135.0–407.5) | 206.0 (133.0–381.3) | 296.0 (180.0–570.0) | 0.001 |
Procedural success [n (%)] | 892 (84.5) | 847 (86.3) | 45 (60.8) | < 0.001 |
Echocardiographic data | ||||
LVEF (%) | 47.3 ± 12.0 | 48.0 ± 11.5 | 35.7 ± 14.9 | < 0.001 |
LVEDD (mm) | 51.4 ± 5.0 | 51.4 ± 5.0 | 51.2 ± 4.8 | 0.897 |
E/E’ | 11.9 ± 5.2 | 11.8 ± 5.2 | 12.8 ± 4.7 | 0.564 |
Predictors of 1-year mortality
Variables | Univariate analysis | Multivariate analysis | ||||
---|---|---|---|---|---|---|
HR | 95% CI | p value | HR | 95% CI | p value | |
Age (per 10-year-old increase) | 1.960 | 1.621–2.370 | < 0.001 | 1.416 | 1.097–1.828 | 0.008 |
Male | 0.610 | 0.371–1.003 | 0.051 | 1.783 | 0.802–3.962 | 0.156 |
Body weight < 67 kg | 1.807 | 1.123–2.907 | 0.015 | 1.555 | 0.735–3.291 | 0.249 |
Diabetes mellitus | 1.824 | 1.146–2.903 | 0.011 | 1.062 | 0.496–2.272 | 0.878 |
Hypertension | 1.655 | 1.045–2.621 | 0.032 | 0.970 | 0.489–1.923 | 0.930 |
Systolic BP < 100 mmHg | 4.459 | 2.770–7.178 | < 0.001 | 2.568 | 1.357–4.860 | 0.004 |
Heart rate > 100 beats/minute | 3.022 | 1.796–5.085 | < 0.001 | 1.239 | 0.548–2.802 | 0.606 |
Killip class II–IV | 5.445 | 3.455–8.581 | < 0.001 | 2.426 | 1.367–4.303 | 0.002 |
LVEF < 40% | 5.080 | 2.981–8.658 | < 0.001 | 1.889 | 1.008–3.541 | 0.047 |
Anterior wall infarction | 2.061 | 1.261–3.366 | 0.004 | 2.084 | 1.056–4.114 | 0.034 |
Multivessel disease | 1.526 | 0.928–2.509 | 0.095 | 1.047 | 0.511–2.144 | 0.900 |
Post-TIMI flow < 3 | 3.782 | 2.371–6.032 | < 0.001 | 1.843 | 1.006–3.379 | 0.048 |
Hypoxic liver injury* | 3.631 | 2.308–5.710 | < 0.001 | 2.019 | 1.104–3.695 | 0.023 |
Dysglycemia† | 5.008 | 3.173–7.904 | < 0.001 | 2.535 | 1.324–4.855 | 0.005 |
Anemia | 3.702 | 2.338–5.863 | < 0.001 | 2.071 | 1.093–3.923 | 0.026 |
NLR > 4.3 | 3.796 | 2.336–6.166 | < 0.001 | 3.651 | 1.927–6.918 | < 0.001 |
Estimated GFR < 60 mL/min/1.73 m2 | 3.879 | 2.454–6.131 | < 0.001 | 0.791 | 0.364–1.720 | 0.554 |
Peak CK-MB (log) | 1.637 | 0.951–2.821 | 0.075 | 1.228 | 0.618–2.441 | 0.558 |
Symptom to balloon time > 4 h | 2.094 | 1.316–3.333 | 0.002 | 1.477 | 0.731–2.988 | 0.277 |
Prognostic value of HLI, dysglycemia, NLR, and anemia over the TIMI risk score
1-year mortality | Model using blood biomarkers† plus TIMI risk score | |||
---|---|---|---|---|
Low risk (< 1%) | Moderate risk (1–5%) | High risk (> 5%) | Total | |
Model using TIMI risk score | ||||
No events | ||||
Low risk (< 1%) | 176 (88.44) | 23 (11.56) | 0 (0) | 199 |
Moderate risk (1–5%) | 164 (37.88) | 226 (52.19) | 43 (9.93) | 4331 |
High risk (> 5%) | 0 (0) | 101 (28.86) | 249 (71.14) | 350 |
Total | 340 | 350 | 292 | 982 |
Events | ||||
Low risk (< 1%) | 1 (100.0) | 0 (0) | 0 (0) | 1 |
Moderate risk (1–5%) | 1 (12.50) | 4 (50.0) | 3 (37.50) | 8 |
High risk (> 5%) | 0 (0) | 2 (3.03) | 64 (96.97) | 66 |
Total | 2 | 6 | 67 | 75 |
NRI = 0.203 (95% CI 0.130–0.275) IDI = 0.089 (95% CI 0.060–0.119) |