Predictors of Mortality and Long-Term Outcome in Patients with Anterior STEMI: Results from a Single Center Study
Giulia Ferrante1, Lucia Barbieri2, Carlo Sponzilli1
1Division of Cardiology, ASST Santi Paolo e Carlo, 20142 Milan, Italy.
Insights
Anterior ST-elevation myocardial infarction (A-STEMI) patients face poor outcomes, especially with cardiogenic shock. Left ventricular ejection fraction (LV-EF) strongly predicts mortality, while revascularization strategy showed no significant impact.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Anterior ST-segment elevation myocardial infarction (A-STEMI) carries the highest mortality risk due to extensive myocardial damage.
- Prompt reperfusion therapy is crucial, but outcomes remain challenging.
Purpose of the Study:
- To analyze predictors of mortality and the impact of revascularization strategies in A-STEMI patients.
- To evaluate outcomes in patients with and without cardiogenic shock (CS).
Main Methods:
- Retrospective analysis of 584 A-STEMI patients undergoing urgent coronary angiography (2008-2019).
- Assessment of in-hospital and long-term mortality (median 1774 days follow-up).
- Evaluation of predictors including left ventricular ejection fraction (LV-EF), estimated glomerular filtration rate (eGFR), and cardiogenic shock (CS).
Main Results:
- In-hospital mortality was 8.6%, with 18.8% long-term all-cause mortality.
- Key predictors for in-hospital mortality included LV-EF, eGFR, female gender, and CS.
- Long-term mortality predictors were age, coronary artery disease (CAD) extension, and LV-EF.
- Patients with CS (6.5%) had significantly higher mortality (in-hospital 68.4%, long-term 41.7%).
- Complete revascularization (CR) in multivessel disease (MVD) did not improve short- or long-term mortality compared to culprit-only revascularization.
Conclusions:
- A-STEMI patients are extremely vulnerable, particularly those with cardiogenic shock.
- LV-EF is a critical determinant of prognosis in A-STEMI.
- Current revascularization strategies (CR vs. culprit-only) do not significantly alter mortality outcomes in MVD patients with A-STEMI.
Abstract:
Anterior ST segment elevation myocardial infarction (A-STEMI) has the worst prognosis among all infarct sites due to larger infarct size and the higher cardiac enzyme release. We retrospectively analyzed 584 A-STEMI undergoing urgent coronary angiography from October 2008 to April 2019. The median follow-up time was 1774 days with a minimum of a 1-year follow-up for 498 patients. In-hospital mortality was 8.6%, while long-term, all-cause mortality and 1-year mortality were 18.8% and 6.8%, respectively. The main predictors for in-hospital mortality were ejection fraction (LV-EF), baseline estimated glomerular filtration rate (eGFR), female gender and cardiogenic shock (CS) at admission, while long-term predictors of mortality were age, coronary artery disease (CAD) extension and LV-EF. Patients presenting with CS (6.5%) showed a higher mortality rate (in-hospital 68.4%, long term 41.7%). Among 245 patients (42%) with multivessel disease (MVD), complete revascularization (CR) during the index procedure was performed in 42.8% of patients and more often in patients with CS at admission (19.1% vs. 6.1%, p = 0.008). Short- and long-term mortality were not significantly influenced by the revascularization strategy (CR/culprit only). Our study confirmed the extreme fragility of A-STEMI patients, especially in case of CS at admission. LV-EF is a powerful predictor of a poor outcome. In MVD, CR during p-PCI did not show any advantage for either long- or short-term mortality compared to the culprit-only strategy.
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