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Arch Iran Med. 2020;23(8): 514-521.
doi: 10.34172/aim.2020.53
  Abstract View: 124
  PDF Download: 118

Original Article

Twelve-Year History of STEMI Management in Tehran Heart Center: Concomitant Reduction of In-Hospital Mortality and Hospitalization Length

Seyedmohammad Saadatagah 1 ORCID logo, Saeed Ghodsi 1, Negar Omidi 1, Hamidreza Poorhosseini 1, Mojtaba Salarifar 1, Saead Sadeghian 1, Mohammad Alidoosti 1, Seyed Ebrahim Kassaian 1, Hassan Aghajani 1, Seyedeh Hamideh Mortazavi 1, Kaveh Hosseini 1, Babak Geraiely 1 * ORCID logo

1 Tehran Heart Center (THC), Tehran University of Medical Sciences, Tehran, Iran
*Corresponding Author: Babak Geraiely, MD; Interventional Cardiologist, Tehran Heart Center, Tehran University of Medical Science, Tehran, Iran. Tel: +9821 880 29 600; Fax: +9821 880 29 731; Email: babak_geraiely@yahoo.com

Abstract

Background: Cardiovascular-related death remains the major cause of mortality in Iran despite significant improvements in its care. In the present study, we report the in-hospital mortality, hospitalization length, and treatment methods for patients with ST-elevation myocardial infarction (STEMI) in Tehran Heart Center (THC).

Methods: Records pertaining to patients with STEMI from March 2006 to March 2017 were extracted from the databases of THC. Besides a description of temporal trends, multivariable regression analysis was used to find factors associated with in-hospital mortality.

Results: During the study period, 8,295 patients were admitted with STEMI with a mean age of 60.4 ± 12.5 years. Men accounted for 77.5% of the study population. Hospitalization length declined from 8.4 to 5.2 days, and in-hospital mortality was reduced from 8.0% to 3.9% (both P values < 0.001). In a multivariable model adjusted for age, sex, conventional cardiac risk factors, prior cardiac history, and indices of event severity, primary percutaneous coronary intervention (PCI) (OR: 0.280, 95% CI: 0.186 to 0.512; P<0.001), coronary artery bypass graft (CABG) surgery (OR: 0.482, 95% CI: 0.220 to 0.903; P=0.025), and rescue or facilitated PCI (OR: 0.420, 95% CI: 0.071 to 0.812; P=0.001) were all associated with reduced in-hospital mortality in comparison with medical treatment. Furthermore, primary PCI was a crucial protective factor against prolonged length of hospital stay (OR: 0.307, 95% CI: 0.266 to 0.594; P<0.001).

Conclusion: In-hospital mortality and hospitalization length were almost halved during the study period, and primary PCI has now replaced thrombolysis in the management of STEMI.

Keywords: Coronary artery disease, Fibrinolytic agents, Hospital mortality, Percutaneous coronary intervention, Reperfusion, ST-elevation myocardial infarction
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