Evaluation of Predictors of Mortality Among Patients with Acute Myocardial Infarction

Abstract

Objective: To evaluate demographic, clinical, laboratory, and treatment-related predictors associated with mortality among patients with acute myocardial infarction admitted to a tertiary care hospital in Peshawar.

Methodology:A retrospective observational study was conducted in the Department of Cardiology from June 2023 to June 2024. A total of 120 adult patients diagnosed with acute myocardial infarction were included through consecutive sampling. Data regarding demographic characteristics, comorbidities, clinical presentation, laboratory findings, treatment received, and hospital outcomes were collected from medical records. Associations between predictors and mortality were assessed using Chi-square/Fisher’s exact tests, independent sample tests, and multivariable logistic regression. A p-value <0.05 was considered statistically significant.

Results: Among 120 patients, 106 (88.3%) survived and 14 (11.7%) died during hospital admission. The mean age of patients was 60.26±15.79 years. Most patients were male 91 (75.8%), while 65 (54.2%) presented with STEMI and 55 (45.8%) with NSTEMI. Diabetes mellitus was present in 66 (55.0%) patients and hypertension in 62 (51.7%). Cardiogenic shock was significantly more frequent among non-survivors compared with survivors (12 (85.7%) vs 46 (43.4%), p=0.007). In multivariable logistic regression, cardiogenic shock remained the strongest independent predictor of mortality (adjusted OR=10.39, 95% CI: 2.10–51.39, p=0.004). Higher Killip class was also independently associated with mortality (adjusted OR=1.77, 95% CI: 1.03–3.05, p=0.039). Age, diabetes mellitus, hypertension, creatinine, troponin level, and primary PCI were not significant independent predictors.

Conclusion: Cardiogenic shock and higher Killip class were the main predictors of in-hospital mortality among patients with acute myocardial infarction. Early identification of haemodynamic instability may improve risk stratification and guide timely management. Larger multicentre prospective studies are recommended to validate these findings and develop locally applicable AMI mortality prediction models.

Keywords: Acute Myocardial Infarction; Mortality; Cardiogenic Shock; Risk Factors; Prognosis.