Prognostic factors associated with poor outcomes in Código Infarto patients

Jessica M. Bazo-Medina, Department of Cardiology, Hospital General de México Dr. Eduardo Liceaga, Secretaría de Salud, Mexico City, Mexico
Rodolfo de J. Castaño-Guerra, Department of Cardiology, Hospital General de México Dr. Eduardo Liceaga, Secretaría de Salud, Mexico City, Mexico
Belinda E. González-Díaz, Interventional Cardiology Service, Unidad Médica de Alta Especialidad, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico

Introduction: In our country, ischemic heart disease remains the leading cause of death, and its incidence continues to increase rapidly. Most patients treated at our center with a diagnosis of acute coronary syndrome (ACS) have a late presentation. Objective: We conducted this study to identify the factors that impact patient outcomes within the Código Infarto program. Material and methods: A retrospective cohort study was conducted from January 2023 to January 2024, including 230 patients. Patients were classified according to time to presentation (< 12 h and ≥ 12 h). The primary outcome was in-hospital mortality. Survival was estimated using Kaplan-Meier curves and compared between groups using the log-rank test. To identify prognostic factors associated with mortality, a Cox proportional hazards regression model was used, reporting hazard ratios with 95% confidence intervals. Results: Late presentation occurred in 51.7% of patients, with a mean total ischemic time of 14 h. Overall mortality was 20.4%. No significant difference in survival was observed between early and late presentation groups (log-rank p = 0.620). In multivariable analysis, mortality was significantly associated (p < 0.005) with the presence of chronic kidney disease, acute heart failure, cardiogenic shock, and arrhythmias or complete atrioventricular block. Conclusions: In this cohort of patients with acute myocardial infarction, in-hospital mortality was high. Although late presentation was frequent, the main prognostic determinants of mortality were related to clinical severity and the presence of comorbidities, highlighting the importance of early identification of high-risk patients.

Keywords: Acute myocardial infarction. Prognosis. Mortality.