The factors associated with the 30-day mortality rate of patients with acute myocardial infarction in the intensive care unit
Keywords:
acute myocardial infarction, 30-day mortality, fasting plasma glucose, heart failure, cardiogenic shockAbstract
Acute myocardial infarction is a significant health problem worldwide and is the leading cause of death globally and in Thailand. This study aimed to analyze factors affecting the 30-day mortality rate of acute myocardial infarction in the intensive care unit at Pranangklao Hospital. It was a retrospective cohort study, collecting data from January 1 to December 31, 2023, with a total of 116 cases. Data were analyzed using descriptive statistics and multivariate logistic regression analysis. The study results showed that the 30-day mortality rate for acute myocardial infarction was 13%. Statistically significant factors associated with mortality included age (Adj OR = 1.119, p=0.029), heart failure (Adj OR = 26.351, p=0.014), cardiogenic shock (Adj OR = 6.835, p=0.012), fasting blood glucose level (Adj OR = 1.021, p=0.008), VT/VF arrhythmia (Adj OR = 18.008, p=0.019), and treatment with Intra-Aortic Balloon Pump (IABP) support (Adj OR = 234.321, p=0.009). Meanwhile, systolic blood pressure was found to be a protective factor against mortality (Adj OR = 0.955, p=0.011). When analyzing the cut-off points of the ROC curve using the Youden Index, it was found that age above 64.5 years, blood pressure below 70 mmHg, and fasting blood glucose level above 178 mg/dL were associated with a higher risk of mortality. In conclusion, the key factors affecting 30-day mortality in AMI patients in the ICU include advanced age, heart failure, cardiogenic shock, low systolic blood pressure, high fasting blood glucose levels, VT/VF arrhythmias, and the use of IABP for cardiac support. To reduce mortality rates in acute myocardial infarction patients, it is important to focus on strict blood glucose control, vigilant monitoring of vital signs, heart failure symptoms, and ECG for arrhythmia detection, along with rapid and effective management. The use of IABP should be carefully considered, weighing the risks and benefits for each patient.
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