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Predictors of Major Adverse Cardiovascular Events in Stable Patients After ST Elevation Myocardial Infarction
Lidija Savic1,2, Damjan Simic2, Ratko Lasica1,2
1Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
Insights
Four key predictors identify stable patients post-ST-elevation myocardial infarction (STEMI) at higher risk for major adverse cardiovascular events (MACE). These factors include age, reduced ejection fraction, diabetes, and multi-vessel coronary artery disease.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- ST-elevation myocardial infarction (STEMI) survivors require long-term risk stratification.
- Identifying stable post-STEMI patients at high risk for major adverse cardiovascular events (MACE) is crucial for effective secondary prevention.
Purpose of the Study:
- To determine predictors of MACE in stable patients following STEMI.
- To identify specific risk factors associated with long-term adverse cardiovascular outcomes in this population.
Main Methods:
- Analysis of 3079 patients from a STEMI Register treated with primary percutaneous coronary intervention (PCI).
- Exclusion of patients with cardiogenic shock at admission.
- Eight-year follow-up to assess MACE and its components.
Main Results:
- At eight years, MACE occurred in 3.9% of stable post-STEMI patients.
- Significant predictors for 8-year MACE included age >60 years, ejection fraction <50%, diabetes mellitus, and 3-vessel coronary artery disease.
- Specific hazard ratios (HR) were reported for different age and ejection fraction categories.
Conclusions:
- Four predictors (age, EF, diabetes, 3-vessel CAD) identify stable post-STEMI patients at elevated MACE risk.
- These findings suggest a need for personalized secondary prevention strategies for high-risk individuals.
- Targeted interventions may improve long-term prognosis in stable STEMI survivors.
Background/Aim:
The aim of this study was to determine predictors of major adverse cardiovascular events, including MACE (mortality, non-fatal recurrent infarction, non-fatal stroke, and target vessel revascularization-TVR) in stable post-STEMI patients.
Method:
We analyzed STEMI patients without cardiogenic shock at admission included in our STEMI Register. The patients were treated with primary PCI. The follow-up period was eight years.
Results:
From 1 December 2006 to 31 December 2016, a total of 3079 patients were included in the Register. In the first year, MACE was registered in 348 (11.3%) patients. The remaining patients were considered stable. They were included in further analysis. At eight years, the rates were as follows: MACE 3.9%, non-fatal recurrent infarction 2.1%, TVR 1.8%, non-fatal stroke 0.5%, and mortality 2.1%. Predictors for 8-year MACE were age >60 years (60-69 vs. <60 years HR 1.65; 70-79 vs. <60 years HR 1.82; ≥80 vs. <60 years HR 3.16), EF < 50% (EF 40-49% HR 2.38; EF < 40% HR 2.32), diabetes mellitus (HR 1.49), and 3-vessel coronary artery disease (HR 1.44).
Conclusions:
Four predictors identified stable post-STEMI patients who remained at a higher risk for the occurrence of MACE. Stable post-STEMI patients with one or more of these risk factors may require more aggressive secondary prevention measures or a personalized approach to improve their prognosis.
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