Risk factors for in-hospital death in acute ST-segment elevation myocardial infarction after emergency percutaneous coronary intervention: a multicenter retrospective study

Background: For some acute ST-segment elevation myocardial infarction (STEMI) cases, the risk of in-hospital death remains high even after emergency percutaneous coronary intervention (PCI). This study sought to identify predictors of in-hospital mortality in STEMI patients after PCI. Methods: Patients with acute STEMI, who underwent emergency PCI at Hebei General Hospital, Baoding First Central Hospital, and Cangzhou Central Hospital, from January 2016 to December 2018, were retrospectively included in this study. The patients' general data, previous medical history, clinical data and medication data were collected and compared between the survival and mortality groups. The primary outcome was in-hospital mortality. In-hospital mortality was defined as all-cause death during admission. Results: Of the 1,169 patients (876 male and 293 female) enrolled in this study, 95 (8.13%) died during hospitalization. The multivariate logistic regression analysis showed that being female [odds ratio (OR) = 5.86, 95% confidence interval (CI): 2.03-16.92, P=0.001], a Killip class of 2 (OR = 8.13, 95% CI: 2.03-32.61, P=0.003), a Killip class of 4 (OR = 17.31, 95% CI: 3.69-81.27, P=0.001), a left main coronary artery lesion (OR = 44.25, 95% CI: 3.96-494.05, P=0.002), a final TIMI flow of 1 (OR = 171.83, 95% CI: 28.46-1037.51, P=0.001), a final TIMI flow of 2 (OR = 72.93, 95% CI: 38.54-138.00, P=0.001), symptom onset-to-door time (SDT) (OR = 1.01, 95% CI: 1.00-1.02, P=0.001), symptom onset-to-balloon dilatation time (SBT) (OR = 1.01, 95% CI: 1.00-1.02, P=0.001), and the Synergy Between PCI With Taxus and CABG (SYNTAX) score (OR = 1.07, 95% CI: 1.01-1.12, P=0.019) were risk factors; while postoperative beta-receptor blockers (OR = 0.10, 95% CI: 0.03-0.30, P=0.001) postoperative angiotensin-converting enzymes/angiotensin receptor blockers (OR = 0.13, 95% CI: 0.04-0.44, P=0.001), BMI (OR = 0.85, 95% CI: 0.74-0.98, P=0.024), the percentage of the ejection fraction (OR = 0.81, 95% CI: 0.75-0.86, P=0.001), and low-density lipoprotein cholesterol (OR = 0.44, 95% CI: 0.21-0.91, P=0.027) were protective factors for in-hospital mortality. Conclusions: Female, Killip grade, a left main lesion, TIMI grade, SDT, SBT, and SYNTAX score were associated with a higher risk of in-hospital death. Conversely, BMI, ejection fraction, LDL-C level, and postoperative use of beta-blocker and ACEI/ARB drugs were associated with a lower in-hospital death risk.