ST-segment elevation myocardial infarction heart of Charlotte one-year (STEMI HOC-1) study: a prospective study
Marheb Badianyama1, Arthur Mutyaba1, Samantha Nel1
1Division of Cardiology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 2193, Johannesburg, South Africa.
Insights
This study investigated one-year mortality in South African ST-segment elevation myocardial infarction (STEMI) patients. It found serum uric acid may predict mortality, offering insights for public healthcare strategies.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Biomarker Research
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical complication of ischaemic heart disease (IHD).
- Acute STEMI mortality is rising in sub-Saharan Africa (SSA), with limited data from South Africa's public sector.
- This study addresses the data gap on one-year clinical outcomes for acute STEMI patients in South Africa.
Purpose of the Study:
- To determine the one-year all-cause mortality rate for acute STEMI.
- To assess the predictive value of cardiac biomarkers and serum uric acid for all-cause mortality in STEMI patients.
- To provide insights for risk stratification, prognostication, and management of STEMI in South Africa.
Main Methods:
- A single-centre, observational, prospective cohort study at Charlotte Maxeke Johannesburg Academic Hospital.
- Inclusion of 355 consecutive patients presenting with acute STEMI.
- Data collection via electronic records, lab results, coronary angiography, telephonic interviews, and echocardiograms over one year.
Main Results:
- The study will provide demographic, risk factor, and clinical profiles of STEMI patients.
- Comparison of outcomes across different coronary reperfusion strategies will be analyzed.
- The prognostic value of baseline serum uric acid as a low-cost biomarker will be evaluated.
Conclusions:
- Findings will inform risk stratification and therapeutic management of STEMI patients in South Africa.
- Results may guide treatment strategies, especially where percutaneous coronary intervention access is limited.
- The study offers public health significance for policymakers regarding prevention and referral networks.
Background:
ST-segment elevation myocardial infarction (STEMI) is a clinically distinguishable yet lethal sequela of ischaemic heart disease (IHD). In sub-Saharan Africa (SSA), death due to acute STEMI is increasing. In South Africa, there is a paucity of data available on the clinical outcomes of acute STEMI within one year for individuals treated in the public healthcare sector. This study primarily seeks to determine the one-year all-cause mortality rate of acute STEMI. The study also assesses the value of serum cardiac biomarkers of myocardial damage and serum uric acid in predicting all-cause mortality in STEMI.
Methods:
This is a single-centre observational prospective cohort of all consecutive individuals presenting with an acute STEMI to the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in Johannesburg, South Africa. Research data will be sourced on admission through electronic medical records, blood laboratory results and coronary angiography reports, and at follow-up through periodic telephonic interviews and standardised echocardiograms. At least 355 eligible participants will be continuously followed over one year, and clinical outcomes will be measured 30 days, three months, six months and one year after the index hospitalisation.
Discussion:
This study provides insights into the demographic, risk factors and clinical profiles of individuals with STEMI in South Africa. Its findings may improve the risk stratification, prognostication, and therapeutic management of STEMI patients in our setting. By comparing the clinical outcomes between the different coronary reperfusion strategies, our results may guide clinicians in providing better patient treatment, particularly in sub-Saharan Africa, where access to percutaneous coronary intervention may be limited. Furthermore, the study offers insights into the routine use of baseline serum uric acid as a potential low-cost prognostic biomarker of all-cause mortality in STEMI. Finally, this study's findings may be of public health significance to local policymakers to aid in reinforcing primary prevention strategies and developing structured referral networks for timely coronary reperfusion of acute STEMI.
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