Triggering type and long-term survival following ST segment elevation-myocardial infarction treated with primary
Moaad Slieman1,2, Inbal Greenberg2, Zach Rozenbaum1,2
1Department of Cardiology, Tel-Aviv Sourasky Medical Center.
Insights
Emotional stress triggers ST-elevation myocardial infarction (STEMI) with better long-term survival post-percutaneous coronary intervention (PCI) than physical stress. Identifying trigger type is crucial for STEMI patient prognosis.
Area of Science:
- Cardiology
- Psychocardiology
- Clinical Research
Background:
- Physical and emotional stress are known triggers for acute coronary syndromes like ST-segment elevation myocardial infarction (STEMI).
- Previous research indicates triggers precede STEMI in over a third of patients and correlate inversely with coronary artery disease (CAD) extent.
- This study examines the impact of trigger type (physical vs. emotional) on long-term mortality in STEMI patients undergoing primary percutaneous coronary intervention (PCI).
Purpose of the Study:
- To investigate the association between the type of trigger (physical or emotional) and long-term mortality in STEMI patients treated with primary PCI.
- To determine if emotional triggers are associated with different long-term outcomes compared to physical triggers or no triggers.
Main Methods:
- Retrospective, single-center observational study of STEMI patients treated with primary PCI between January 2008 and December 2013.
- Triggers (physical and emotional) were identified retrospectively from patient records.
- Mortality data were collected from the Israeli Ministry of Health.
Main Results:
- Of 1267 STEMI patients with available mortality data, 36.5% had identifiable triggers (85% physical, 15% emotional).
- Triggered STEMI patients were younger, had fewer comorbidities, and less multi-vessel CAD than non-triggered patients.
- Emotionally triggered STEMI patients demonstrated improved long-term survival post-PCI compared to those with physical triggers or no triggers, with emotional triggering being an independent predictor of enhanced survival.
Conclusions:
- Emotionally triggered STEMI is associated with less extensive coronary artery disease (CAD) and better long-term survival after PCI compared to physically triggered STEMI.
- The type of stress trigger preceding STEMI is an important factor influencing patient prognosis and long-term outcomes following PCI.
- Clinical management and prognostic assessment of STEMI patients should consider the presence and specific type of stress trigger.
Background:
Physical and emotional stress are recognized triggers of acute coronary syndromes, including ST segment elevation-myocardial infarction (STEMI). We have previously shown that identifiable triggers precede symptoms in over one-third of STEMI patients and inversely correlate with the extent of coronary artery disease (CAD). This study aims to investigate the association between trigger type (physical vs. emotional) and long-term mortality in STEMI patients treated with primary percutaneous coronary intervention (PCI).
Methods:
This retrospective, single-center observational study included all patients admitted with an STEMI diagnosis from January 2008 to December 2013. Physical and emotional triggers were identified retrospectively from patient records. Mortality data were obtained from the Israeli Ministry of Health.
Results:
Of 1345 consecutive STEMI patients treated with primary PCI, mortality data were available for 1267 patients (median age: 61 years). A trigger preceding symptoms onset was identified in 36.5% of patients, with 85% experiencing physical stress and 15% emotional stress. Triggered STEMI patients tended to be younger with fewer comorbidities and lower incidence of multiple vessel CAD compared with nontriggered patients. Notably, emotionally triggered STEMI patients exhibited improved long-term survival compared with those without emotional triggers or with physical triggers. Emotional triggering was identified as an independent predictor of enhanced long-term survival post-PCI compared with physical triggering.
Conclusion:
Patients with emotionally triggered STEMI showed less extensive CAD and improved long-term survival following PCI compared with those with physically triggered STEMI. These findings highlight the importance of considering both the presence and type of trigger in the management of STEMI patients and their long-term prognosis.
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