CLINICAL AND ECHOCARDIOGRAPHIC PREDICTORS OF IN-HOSPITAL MORTALITY IN ST ELEVATION MYOCARDIAL INFARCTION IN A TERRITORY CARE CENTER.

Dr. P. Kannan, Dr. T. Munusamy

Abstract


Background: The most important clinical factors of in-hospital mortality in STEMI are killip class, age, Blood pressure and heart rate and diabetes
mellitus. In contrast, systemic hypertension with left ventricular hypertrophy has modestly favourable impact our in-hospital mortality in patients
with STEMI.
Methods: Patients were included in this study if they fullled the following criteria. Patients with Acute STEMI within seven days of MI.
Demographic, clinical, diagnostic, management and survival data were obtained and recorded. Age and Sex distribution, risk factor distribution,
Hypertension diabetes, dyslipidemia, s moking, family history of premature CAD was identied and recorded.
Results: A total of 705 patients were enrolled and number of patient in survival group 662 and in mortality group 43.Out of 705 patients,322
patients received Thrombolytic therapy(46.2%) among which 282 patients (89.2%) survived and 40 patients (10.8%) died. Thrombolytic therapy
was successful (>50% resolution) in 110 patients. Signicant 12.23% number of patients who had successful Thrombolysis survived (34.8 %) few
deaths (10%) occurred after successful Thrombolysis.
Conclusion: In conclusion, the electrocardiographic characteristics associated with higher in hospital mortality are ST segment resolution <50%,
ST depression is in non infarct leads and arrhythmias. Bedside 2 dimensional and Doppler Echo cardiogarphy provides additional prognostic
information over clinical and biological parameters that are routinely determined in patients presenting with STEMI.


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References


Goldberg R.J, Core JM, Alpart JS et al. Cardiographic shock after acute myocardial infarction incidence and mortality from a community wide prospective 1975 to 1988 N.Eng 1J. med (1991; 325;1117 -1122)

Gray D, Keating et, Stena Am et al, myocardial infarction in patients over 75 1982-1990. Q.J med 1992; 84: 659-69

Girnes CL, Browone KF, Morco J et al. Comparison of immediate angioplasty with Thrombolytic therapy for acute myocardial infarction N.Eng J med 1993:328 & 673-9

MCVoren PG, Penkow JS, Shaher E, et al. Recent trends in acute coronary heart disease mortality, morbidity, medical care and risks factors N Eng J Med. 1996 334,884-90

Ommen SR Nishiuna RA, Appleton CP et al. Clinical utility of Doppler echocardiograpy and tissue Doppler imaging in the estiation of Left ventricular filling pressures, a comparative simultaneous Doppler catheterization study. Circulation 2000: 102, 1788-1790.

Kinch JW, Ryan TS, Right ventricular infarction N Eng J.Med. 1994:330:1211-7

Berger PB, Ryan TS, inferior myocardial infarction- high risk sub groups. Circulation 1990:81;401-11.

Viestra RC, Kronmol RD, Frye AL et al, Factors affecting the extent and severity of coronary artery disease in patients enrolled in the coronary artery surgery study Arteriosclerosis on. 1982;2;208-lr

Yusuf S. Flether M, Pogu J, et al. Variations between countries in invasive cardiac procedures and outcomes in patients suspend unstable angina or myocardial infarction without initial ST elevation Lancet 1998: 352;507-14

Alonso Dr, Schelir S. Post M et.al pathophysiology of cardiogenic shocked quantification of myocardial necrosis, clinical strategic and electrocardiographic correlation. Circulation. 1973; 48; 588-596

Menov. Slate VN, White HD, et al. Acute myocardial infarction complicated by systemic hypoperfusion without hypotension report of the shock trail registry. Am.J med 2000;108;374-380.

Cotter G, moshkovitz Y. Milovan O. et al Acute heart failure a normal approach to its pathogenesis and treatment Eur.J. Heart fail. 2002;4;227-234.

Kohsaua S.Menon V, Lenge M. et al, High incidence of sepsis complicating cardiogenic shock following acute myocardial infarction circulation 2001.

Schulz R, Wambolt R, Inhibition of nitric oxide synthesis protects Re isolated working rabbit from Ischenic reperfusion injury cardiovas Res 1995:30:432-439

Godley RW, Wann LS, Rogan EW, er al, Incomplete leaflet closure in patients with papillary muscle dysfunction circulation 1981;63;565-571.

Temporell PL, Gienuzzi P, Nicolos GC er al. Doppler derived mitral declaration time as a strong prognostic matter of left ventricular remodeling and survival after acute myocardial infarction results of the GISSI-3 echo subsequently J Am. COll Cardiology 2004;43;1646-53

Aillis G.S, Mollur JE, Palkikth PP er al. Non-invasive estimation of left ventricular filling pressure by E./e’ is a powerful predictor of survival after acute myocardial infarction J Am Coll. Cardiology(2004) 43.360-7

Pozzli M, Capohella S. Samerit M, er al. Doppler evaluation of left ventricular diastolic filling and pulmonary wedge pressure provide similar prognostic infarction in patients with systolic dysfunction after myocardial infarction Am. Aeart J (1995) 929;716-25

Naguesh SF, Milear I, Kopelen HA er.al, Doppler estimation of left ventricular filling pressure in sinus tachycardia. A new application of tissue Doppler imaging Circulation (1998) 98;1644-50

Ennezet PV, Merechaux S, Assema P at al functional mitral regurgitation and chronic heart failure. Minarva cardiological (2006) 54;725-33

Hillis GS, Molur JF,Oh-JK et al. Prognostic significance of echocardiographically defined mitral regurgitation early after myocardial infarction Am Heart J. (2005) 150;12668-75.


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