Cardiac Output as Predictor of In-Hospital Mortality

Patients with ST-Elevation Myocardial Infarction in Dr

Iskak General Hospital Intensive Cardiac Care Unit
Y. Permana , E. Ruspiono , A.W. Nugraha , F.S. Laitupa , A. Wibisono , T. Astiawati , S. Hayon , N.
1 2 2 2 2 2 1

A. Suyani1, R.G Sungkono1, D.A. Rahmi1, M. A. Kusuma1, Y. D. Larasati3

General Practitioner; Dr. Iskak General Hospital, Tulungagung, East Java, Indonesia
1

2
Cardiologist; Dr. Iskak General Hospital, Tulungagung, East Java, Indonesia
3
Cardiology Department; Dr. Iskak General Hospital, Tulungagung, East Java, Indonesia
 

BACKGROUND AND OBJECTIVE MAIN RESULTS

In STEMI patient, Echocardiography
measurement can be used to evaluate
functional cardiac hemodynamic status
in acute setting.This study seeks to
investigate the independent predictor of
in-hospital mortality in STEMI patients
based on echocardiographic
hemodynamic function.
METHODS
Out of 88 patients, 59 patients (67%) had primary PCI and 29 patients
(33%) had fibrinolysis. In- hospital death occurred in 12 patients.
Based on hemodynamic function, cardiac output was the only
independent predictor for in-hospital mortality (p=0.037, RR 3.873,
95% CI 1.087-13.8).
Chart 1. Hemodynamic Function
In-Hospital Mortality (+)
p = 0.261 In-Hospital Mortality (-)
p = 0.504
p = 0.693 p = 0.958
p = 0.037

This research is using retrospective

study consisted of STEMI patients based
on Dr. Iskak General Hospital acute
coronary syndrome registry from January
2019 to June 2019. Cardiac output
Cardiac Output TAPSE eRAP
during intensive care and also other SVR EF
hemodynamic function such as ejection
fraction (EF), tricuspid annular plane Table 1. Baseline Characteristics
systolic excursion (TAPSE), estimation of
Total Study In-Hospital Mortality In- Hospital Mortality
right atrial pressure (eRAP), systemic   Population (+) (–) P
vascular resistance (SVR) were Table 1. Baseline characteristic
(n=88) (n=12) (n=76)
assessed by echocardiography Age 59.84 ± 10.535 61.17 ± 14.646 59.63 ± 9.847 0.642
Sex
examination. Hemodynamic parameters Male 73 (83%) 9 (75%) 64 (84.2%)
0.422
and in-hospital mortality were assessed Female 15 (17%) 3 (25%) 12 (15.8%)
using multivariate analysis, logistic Systolic Blood Pressure 121.96 ± 32.031 110.83 ± 34.467 120.16 ± 31.616 0.351
Killip Classification
regression, (p<0.05) to investigate the Killip 1 50 (56.8%) 3 (25%) 47 (61.8%)
independent predictor. Killip 2 2 (2.3%) 0 2 (2.6%)
0.028
Killip 3 4 (4.5%) 2 (16.7%) 2 (2.6%)
Killip 4 32 (36.4%) 7 (58.3%) 25 (32.9%)
Infarct Location
Anterior 14 (15.9%) 5 (41.7%) 9 (11.8%) 0.021
Anterior extensif
9 (13.4%) 4 (33.3%) 8 (10.5%) 0.055
 
Inferior 57 (64.8%) 3 (25%) 54 (71.1%) 0.003
Posterior 35 (39.8%) 3 (25%) 32 (42.1%) 0.349
Angiographic
1 VD 9 (10.2%) 0 9 (16.4%) 0.164
2 VD 18 (20.5%) 0 18 (32.7%)  
CONCLUSIONS 3 VD 32 (36.4%) 4 (33.3%) 28 (50.89%)  
Culprit Lesion
LM 2 (2.3%) 0 2 (3.6%) >0.05
Cardiac output as independent predictor RCA 50 (56.8%) 4 (33.3%) 46 >0.05
can be used to evaluate in-hospital LAD 54 (61.4%) 4 (33.3%) 50 (90.9%) >0.05
LCX 37 (42%) 4 (33.3%) 33 (60%) 0.286
mortality in st-elevation myocardial Laboratory Finding
infarction patients. So, it is recommended Blood glucose on admission 219.01±117.851 204.5± 107.924 221.4±119.931 0.648
to use echocardiographic hemodynamic
10217.45 ±
measurement especially cardiac output, Hs-Troponin I 5742.41 ± 12524.181 115834.205 4790.27 ± 11688.454 0.216
for initial evaluation and monitoring
CK-MB 100.15 ± 158.786 202.36 ± 346.781 82.3 ± 90.07 0.02
patient’s outcome during hospitalization.

Keywords: Cardiac output, Echocardiography, Myocardial Infarction, Hemodynamic Function, Mortality.