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Long-term all-cause mortality rate after ST-elevation myocardial infarction and its predictors: ST Elevation
Yasaman Shojaei1, Masoumeh Sadeghi2, Kamran Mehrabani3
1Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Insights
Identifying long-term prognostic factors for ST-elevation myocardial infarction (STEMI) is crucial for improving patient survival. Key predictors of mortality include older age, hypertension, lower ejection fraction, and in-hospital complications.
Area of Science:
- Cardiology
- Public Health
Background:
- ST-elevation myocardial infarction (STEMI) poses a significant global health challenge, particularly in low- and middle-income countries.
- Understanding long-term prognostic factors is essential for enhancing patient outcomes and survival rates.
Purpose of the Study:
- To identify independent predictors of all-cause mortality in patients following ST-elevation myocardial infarction (STEMI).
- To provide insights for improved clinical management and follow-up strategies for STEMI survivors.
Main Methods:
- A 5-year follow-up study of STEMI patients from the SEMI Cohort in Isfahan, Iran.
- Data collection included demographics, medical history, laboratory results, and in-hospital clinical data.
- Univariate and multivariate Cox regression models were used to analyze predictors of mortality.
Main Results:
- Older age, hypertension, lower body mass index, lower initial systolic blood pressure, more affected epicardial territories, and lower ejection fraction were associated with increased mortality.
- Lower hemoglobin levels, higher plasma glucose, and in-hospital complications significantly predicted higher all-cause mortality.
- The study analyzed data from 759 STEMI patients, with 158 deaths recorded over the 5-year follow-up period.
Conclusions:
- Several factors, including demographic, clinical, and in-hospital variables, independently predict long-term mortality after STEMI.
- These findings are critical for risk stratification and tailoring therapeutic interventions to improve STEMI patient care and survival.
Background:
ST-elevation myocardial infarction (STEMI) remains a significant global health concern, especially in low- and middle-income regions. This study aimed to identify long-term prognostic factors among STEMI patients, offering insights into improving patient outcomes.
Materials And Methods:
This study represents the 5-year follow-up of STEMI patients in the SEMI Cohort in Isfahan registry, a clinical-based registry of STEMI patients in Isfahan, Iran, from October 2015. All patients with STEMI within 24 h of symptom onset underwent a comprehensive evaluation. The dataset included demographic information, laboratory data, medical history, and clinical in-hospital data. Over 5 years, annual follow-ups were conducted to track hospitalization and patient all-cause mortality. Utilizing univariate and multivariate Cox regression proportional hazard modeling, we aimed to identify predictors of death.
Results:
In this study, involving 759 patients (621 men and 138 women) with a mean age of 58.92 ± 11.79 years, 158 deaths (21%) with a mean age of 70.33 ± 12.66 years occurred after STEMI. In the multiple model our analysis revealed that the following variables significantly increased all-cause mortality independently: Older age (hazard ratio [HR]: 1.070, P < 0.001), lower body mass index (HR: 0.890, P < 0.001), hypertension status (HR: 2.441, P < 0.001), lower systolic blood pressure at initial presentation (HR: 0.983, P < 0.001), number of affected epicardial territories (HR: 2.979, P < 0.001), lower last ejection fraction before discharge (HR: 0.951, P < 0.001), lower hemoglobin level (HR: 0.747, <0.001), higher plasma glucose level (HR: 1.005, P < 0.001), and in-hospital complications (HR: 7.646, P < 0.001).
Conclusion:
This study identified a range of factors that predict STEMI-related mortality. These findings are pivotal for future planning and decision-making regarding appropriate diagnostic and therapeutic strategies during patient follow-up, contributing to improved outcomes in STEMI care.
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