Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 9, Number 5, October 2018, pages 293-299

Predictors of In-Hospital Mortality in Patients Admitted with Acute Myocardial Infarction in a Developing Country

**Table 1.** Clinical Characteristic of the Study Population
	Total sample	All Patients	STEMI	NSTEMI
CAD: coronary artery disease; MI: myocardial infarction; CHF: congestive heart failure; CABG: coronary artery bypass graft; CKD: chronic kidney disease; PVD: peripheral vascular disease; A-Fib: atrial fibrillation; AV block: atrioventricular block; SBP: systolic blood pressure; HR: heart rate; Hb: hemoglobin; EF: ejection fraction.
Demographic	Mean age	63 ± 13	77 ± 12	< 0.0001	59 ± 13	77 ± 12	< 0.0001	66 ± 13	76 ± 12	0.001
Age > 65 years	216 (47%)	32 (82%)	< 0.0001	79 (38%)	14 (78%)	0.001	137 (54%)	18 (86%)	0.005
Female gender	104 (22%)	15 (39%)	0.02	34 (16%)	5 (28%)	0.20	70 (28%)	10 (48%)	0.05
Cardiac risk factors	Hypertension	234 (50%)	20 (51%)	0.92	77 (37%)	8 (44%)	0.51	157 (62%)	12 (57%)	0.67
Diabetes	142 (31%)	17 (44%)	0.09	48 (23%)	5 (28%)	0.58	94 (37%)	12 (57%)	0.07
Hyperlipidemia	204 (44%)	13 (33%)	0.20	83 (40%)	3 (17%)	0.06	121 (48%)	10 (48%)	1.00
Previous cardiac diseases	h/o CAD	169 (36%)	22 (56%)	0.01	45 (21%)	8 (44%)	0.04	124 (49%)	14 (67%)	0.12
h/o MI	54 (12%)	8 (21%)	0.13	13 (6%)	3 (17%)	0.12	41 (16%)	5 (24%)	0.36
CHF	41 (9%)	12 (31%)	< 0.0001	3 (1%)	4 (22%)	0.001	38 (15%)	8 (38%)	0.01
Previous intervention	Angioplasty	34 (7%)	3 (8%)	1.00	14 (7%)	1 (6%)	1.00	20 (8%)	2 (9.5%)	0.68
CABG	68 (15%)	12 (31%)	0.008	15 (7%)	3 (17%)	0.16	53 (21%)	9 (43%)	0.03
Comorbidities	COPD	21 (4.5%)	4 (10%)	0.12	4 (2%)	2 (11%)	0.07	17 (7%)	2 (9.5%)	0.65
CKD	43 (9%)	11 (28%)	0.001	4 (2%)	3 (17%)	0.01	39 (15%)	8 (38%)	0.01
Stroke	15 (3%)	7 (18%)	0.001	5 (2%)	4 (22%)	0.003	10 (4%)	3 (14%)	0.07
PVD	22 (5%)	5 (13%)	0.05	4 (2%)	1 (6%)	0.34	18 (7%)	4 (19%)	0.07
Admission features	Sinus rhythm	427 (92%)	34 (87%)	0.36	201 (96%)	16 (89%)	0.21	226 (89%)	18 (86%)	0.72
A-Fib	24 (5%)	2 (5%)	1.00	5 (2%)	0(0%)	1.00	19 (7.5%)	2 (9.5%)	0.67
AV block	3 (0.6%)	1 (3%)	0.28	1 (0.5%)	0 (0%)	1.00	2 (0.8%)	1 (5%)	0.21
SBP (mm Hg)	136 ± 29	120 ± 27	0.001	133 ± 29	118 ± 32	0.04	138 ± 28	123 ± 21	0.01
HR	84 ± 22	90 ± 17	0.12	81 ± 21	91 ± 15	0.04	87 ± 23	89 ± 18	0.72
Cr > 2 mg/dL	29 (6%)	9 (23%)	0.001	5 (2%)	4 (22%)	0.003	24 (9%)	5 (24%)	0.04
Hb (g/dL)	13 ± 2	12 ± 2	0.001	14 ± 2	13 ± 2	0.05	13 ± 2	11 ± 2	0.008
Heart failure	40 (9%)	14 (36%)	< 0.0001	11 (5%)	6 (33%)	0.001	29 (11%)	8 (38%)	0.003
Cardiogenic shock	8 (2%)	4 (10%)	0.01	6 (3%)	4 (22%)	0.004	2 (0.8%)	0 (0%)	1.00
Anterior MI	132 (28%)	15 (39%)	0.09	88 (42%)	12 (67%)	0.23	44 (17%)	3 (14%)	0.19
2 vessel CAD	153 (35%)	6 (18%)	0.007	74 (37%)	2 (13%)	0.02	79 (33%)	4 (22%)	0.19
EF (%)	48 ± 14	28 ± 11	< 0.0001	49 ± 12	29 ± 11	< 0.0001	48 ± 15	28 ± 12	< 0.0001

Table 1. Clinical Characteristic of the Study Population

Total sample

All Patients

STEMI

NSTEMI

Survived patients

Deceased patients

P value

Survived patients

Deceased patients

P value

Survived patients

Deceased patients

P value

N = 464

N = 39

N = 210

N = 18

N = 254

N = 21

CAD: coronary artery disease; MI: myocardial infarction; CHF: congestive heart failure; CABG: coronary artery bypass graft; CKD: chronic kidney disease; PVD: peripheral vascular disease; A-Fib: atrial fibrillation; AV block: atrioventricular block; SBP: systolic blood pressure; HR: heart rate; Hb: hemoglobin; EF: ejection fraction.

Demographic

Mean age

63 ± 13

77 ± 12

< 0.0001

59 ± 13

77 ± 12

< 0.0001

66 ± 13

76 ± 12

0.001

Age > 65 years

216 (47%)

32 (82%)

< 0.0001

79 (38%)

14 (78%)

0.001

137 (54%)

18 (86%)

0.005

Female gender

104 (22%)

15 (39%)

0.02

34 (16%)

5 (28%)

0.20

70 (28%)

10 (48%)

0.05

Cardiac risk factors

Hypertension

234 (50%)

20 (51%)

0.92

77 (37%)

8 (44%)

0.51

157 (62%)

12 (57%)

0.67

Diabetes

142 (31%)

17 (44%)

0.09

48 (23%)

5 (28%)

0.58

94 (37%)

12 (57%)

0.07

Hyperlipidemia

204 (44%)

13 (33%)

0.20

83 (40%)

3 (17%)

0.06

121 (48%)

10 (48%)

1.00

Previous cardiac diseases

h/o CAD

169 (36%)

22 (56%)

0.01

45 (21%)

8 (44%)

0.04

124 (49%)

14 (67%)

0.12

h/o MI

54 (12%)

8 (21%)

0.13

13 (6%)

3 (17%)

0.12

41 (16%)

5 (24%)

0.36

CHF

41 (9%)

12 (31%)

< 0.0001

3 (1%)

4 (22%)

0.001

38 (15%)

8 (38%)

0.01

Previous intervention

Angioplasty

34 (7%)

3 (8%)

1.00

14 (7%)

1 (6%)

1.00

20 (8%)

2 (9.5%)

0.68

CABG

68 (15%)

12 (31%)

0.008

15 (7%)

3 (17%)

0.16

53 (21%)

9 (43%)

0.03

Comorbidities

COPD

21 (4.5%)

4 (10%)

0.12

4 (2%)

2 (11%)

0.07

17 (7%)

2 (9.5%)

0.65

CKD

43 (9%)

11 (28%)

0.001

4 (2%)

3 (17%)

0.01

39 (15%)

8 (38%)

0.01

Stroke

15 (3%)

7 (18%)

0.001

5 (2%)

4 (22%)

0.003

10 (4%)

3 (14%)

0.07

PVD

22 (5%)

5 (13%)

0.05

4 (2%)

1 (6%)

0.34

18 (7%)

4 (19%)

0.07

Admission features

Sinus rhythm

427 (92%)

34 (87%)

0.36

201 (96%)

16 (89%)

0.21

226 (89%)

18 (86%)

0.72

A-Fib

24 (5%)

2 (5%)

1.00

5 (2%)

0(0%)

1.00

19 (7.5%)

2 (9.5%)

0.67

AV block

3 (0.6%)

1 (3%)

0.28

1 (0.5%)

0 (0%)

1.00

2 (0.8%)

1 (5%)

0.21

SBP (mm Hg)

136 ± 29

120 ± 27

0.001

133 ± 29

118 ± 32

0.04

138 ± 28

123 ± 21

0.01

84 ± 22

90 ± 17

0.12

81 ± 21

91 ± 15

0.04

87 ± 23

89 ± 18

0.72

Cr > 2 mg/dL

29 (6%)

9 (23%)

0.001

5 (2%)

4 (22%)

0.003

24 (9%)

5 (24%)

0.04

Hb (g/dL)

13 ± 2

12 ± 2

0.001

14 ± 2

13 ± 2

0.05

13 ± 2

11 ± 2

0.008

Heart failure

40 (9%)

14 (36%)

< 0.0001

11 (5%)

6 (33%)

0.001

29 (11%)

8 (38%)

0.003

Cardiogenic shock

8 (2%)

4 (10%)

0.01

6 (3%)

4 (22%)

0.004

2 (0.8%)

0 (0%)

1.00

Anterior MI

132 (28%)

15 (39%)

0.09

88 (42%)

12 (67%)

0.23

44 (17%)

3 (14%)

0.19

2 vessel CAD

153 (35%)

6 (18%)

0.007

74 (37%)

2 (13%)

0.02

79 (33%)

4 (22%)

0.19

EF (%)

48 ± 14

28 ± 11

< 0.0001

49 ± 12

29 ± 11

< 0.0001

48 ± 15

28 ± 12

< 0.0001

**Table 2.** In-Hospital Utilization of Medications and Interventions
	Total sample	All patients	STEMI	NSTEMI
CCB: calcium channel blocker; ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin receptor blocker; LMWH: low molecular weight heparin; GPIIb/IIIa: glycoprotein IIb/IIIa inhibitor; CABG: coronary artery bypass graft; IABP: intra-aortic balloon pump.
In-hospital drugs	Aspirin	433 (93%)	31 (80%)	0.006	202 (96%)	13 (72%)	0.002	231 (91%)	18 (86%)	0.43
Clopidogrel	382 (82%)	19 (49%)	< 0.0001	174 (83%)	6 (33%)	< 0.0001	208 (82%)	13 (62%)	0.04
Beta blocker	289 (62%)	11 (28%)	< 0.0001	136 (65%)	2 (11%)	< 0.0001	153 (60%)	9 (43%)	0.12
CCB	37 (8%)	5 (13%)	0.36	4 (2%)	1 (6%)	0.34	33 (13%)	4 (19%)	0.50
Statin	282 (61%)	5 (13%)	< 0.0001	142 (68%)	0 (0%)	< 0.0001	140 (55%)	5 (24%)	0.006
ACEI	202 (44%)	17 (44%)	0.10	97 (46%)	6 (33%)	0.29	105 (41%)	11 (52%)	0.33
ARB	52 (11%)	3 (8%)	0.79	14 (7%)	0 (0%)	0.61	38 (15%)	3 (14%)	1.00
Heparin	336 (72%)	24 (62%)	0.15	164 (78%)	11 (61%)	0.14	172 (68%)	13 (62%)	0.59
LMWH	174 (38%)	17 (44%)	0.45	66 (31%)	5 (28%)	0.75	108 (43%)	12 (57%)	0.19
GPIIb/IIIa	113 (24%)	3 (8%)	0.02	40 (19%)	1 (6%)	0.21	73 (29%)	2 (9.5%)	0.06
Dopamine	24 (5%)	20 (51%)	< 0.0001	9 (4%)	7 (39%)	< 0.0001	15 (6%)	13 (62%)	< 0.0001
Dobutamine	57 (12%)	25 (64%)	< 0.0001	26 (12%)	11 (61%)	< 0.0001	31 (12%)	14 (67%)	< 0.0001
Amiodarone	83 (18%)	12 (31%)	0.05	30 (14%)	4 (22%)	0.32	53 (21%)	8 (38%)	0.10
In-hospital intervention	Thrombolytic	132 (28%)	2 (5%)	0.002	131 (62%)	2 (11%)	< 0.0001	-	-	-
Angioplasty	166 (38%)	4 (12%)	0.003	101 (51%)	3 (20%)	0.02	65 (27%)	1 (6%)	0.05
CABG	86 (20%)	6 (18%)	0.84	41 (21%)	3 (20%)	1.00	45 (19%)	3 (17%)	1.00
Pace maker	7 (1.5%)	0 (0%)	1.00	4 (2%)	0 (0%)	1.00	3 (1%)	0 (0%)	1.00
IABP	6 (1%)	2 (5%)	0.12	4 (2%)	2 (11%)	0.07	2 (0.8%)	0 (0%)	1.00

Table 2. In-Hospital Utilization of Medications and Interventions

Total sample

All patients

STEMI

NSTEMI

Survived patients

Deceased patients

P value

Survived patients

Deceased patients

P value

Survived patients

Deceased patients

P value

N = 464

N = 39

N = 210

N = 18

N = 254

N = 21

CCB: calcium channel blocker; ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin receptor blocker; LMWH: low molecular weight heparin; GPIIb/IIIa: glycoprotein IIb/IIIa inhibitor; CABG: coronary artery bypass graft; IABP: intra-aortic balloon pump.

In-hospital drugs

Aspirin

433 (93%)

31 (80%)

0.006

202 (96%)

13 (72%)

0.002

231 (91%)

18 (86%)

0.43

Clopidogrel

382 (82%)

19 (49%)

< 0.0001

174 (83%)

6 (33%)

< 0.0001

208 (82%)

13 (62%)

0.04

Beta blocker

289 (62%)

11 (28%)

< 0.0001

136 (65%)

2 (11%)

< 0.0001

153 (60%)

9 (43%)

0.12

CCB

37 (8%)

5 (13%)

0.36

4 (2%)

1 (6%)

0.34

33 (13%)

4 (19%)

0.50

Statin

282 (61%)

5 (13%)

< 0.0001

142 (68%)

0 (0%)

< 0.0001

140 (55%)

5 (24%)

0.006

ACEI

202 (44%)

17 (44%)

0.10

97 (46%)

6 (33%)

0.29

105 (41%)

11 (52%)

0.33

ARB

52 (11%)

3 (8%)

0.79

14 (7%)

0 (0%)

0.61

38 (15%)

3 (14%)

1.00

Heparin

336 (72%)

24 (62%)

0.15

164 (78%)

11 (61%)

0.14

172 (68%)

13 (62%)

0.59

LMWH

174 (38%)

17 (44%)

0.45

66 (31%)

5 (28%)

0.75

108 (43%)

12 (57%)

0.19

GPIIb/IIIa

113 (24%)

3 (8%)

0.02

40 (19%)

1 (6%)

0.21

73 (29%)

2 (9.5%)

0.06

Dopamine

24 (5%)

20 (51%)

< 0.0001

9 (4%)

7 (39%)

< 0.0001

15 (6%)

13 (62%)

< 0.0001

Dobutamine

57 (12%)

25 (64%)

< 0.0001

26 (12%)

11 (61%)

< 0.0001

31 (12%)

14 (67%)

< 0.0001

Amiodarone

83 (18%)

12 (31%)

0.05

30 (14%)

4 (22%)

0.32

53 (21%)

8 (38%)

0.10

In-hospital intervention

Thrombolytic

132 (28%)

2 (5%)

0.002

131 (62%)

2 (11%)

< 0.0001

Angioplasty

166 (38%)

4 (12%)

0.003

101 (51%)

3 (20%)

0.02

65 (27%)

1 (6%)

0.05

CABG

86 (20%)

6 (18%)

0.84

41 (21%)

3 (20%)

1.00

45 (19%)

3 (17%)

1.00

Pace maker

7 (1.5%)

0 (0%)

1.00

4 (2%)

0 (0%)

1.00

3 (1%)

0 (0%)

1.00

IABP

6 (1%)

2 (5%)

0.12

4 (2%)

2 (11%)

0.07

2 (0.8%)

0 (0%)

1.00

**Table 3.** Multivariate Predictors of Mortality
	Predictor	Adjusted OR (95% CI)	P value
CHF: congestive heart failure; CABG: coronary artery bypass graft; EF: ejection fraction; SBP: systolic blood pressure.
All AMI patients	Age (> 65 years)	2.99 (1.22 - 7.36)	0.02
SBP < 100 mm Hg	2.75 (1.12 - 6.76)	0.03
Stroke	4.28 (1.29 - 14.17)	0.02
CABG	2.68 (1.15 - 6.23)	0.02
Admission CHF	3.92 (1.62 - 9.49)	0.002
Plavix	0.25 (0.10 - 0.49)	< 0.0001
EF < 35%	2.32 (1.05 - 5.14)	0.04
STEMI	Age (> 65 years)	3.56 (1.05 - 12.00)	0.041
Admission CHF	5.11 (1.34 - 19.47)	0.017
Stroke	10.43 (2.09 - 52.05)	0.004
EF < 35 %	3.31 (1.03 - 10.62)	0.044
Non-STEMI	Age (> 65 years)	3.97 (1.08 - 14.54)	0.038
Admission CHF	2.49 (0.86 - 7.24)	0.093
CABG	2.42 (0.91 - 6.42)	0.077
EF < 35 %	3.12 (1.13 - 8.66)	0.029

Table 3. Multivariate Predictors of Mortality

Predictor

Adjusted OR (95% CI)

P value

CHF: congestive heart failure; CABG: coronary artery bypass graft; EF: ejection fraction; SBP: systolic blood pressure.

All AMI patients

Age (> 65 years)

2.99 (1.22 - 7.36)

0.02

SBP < 100 mm Hg

2.75 (1.12 - 6.76)

0.03

Stroke

4.28 (1.29 - 14.17)

0.02

CABG

2.68 (1.15 - 6.23)

0.02

Admission CHF

3.92 (1.62 - 9.49)

0.002

Plavix

0.25 (0.10 - 0.49)

< 0.0001

EF < 35%

2.32 (1.05 - 5.14)

0.04

STEMI

Age (> 65 years)

3.56 (1.05 - 12.00)

0.041

Admission CHF

5.11 (1.34 - 19.47)

0.017

Stroke

10.43 (2.09 - 52.05)

0.004

EF < 35 %

3.31 (1.03 - 10.62)

0.044

Non-STEMI

Age (> 65 years)

3.97 (1.08 - 14.54)

0.038

Admission CHF

2.49 (0.86 - 7.24)

0.093

CABG

2.42 (0.91 - 6.42)

0.077

EF < 35 %

3.12 (1.13 - 8.66)

0.029