Echocardiographic grading for long-term mortality risk stratification after first-time ST-segment elevation
Yutong Miao1, Lan Shen2, Li Wang3
1Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights
A simple echocardiographic grading system effectively predicts long-term mortality risk in patients after their first ST-segment elevation myocardial infarction (STEMI). Higher grades indicate increased risk, aiding clinical communication of infarct severity.
Area of Science:
- Cardiology
- Medical Imaging
- Prognostic Biomarkers
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical cardiovascular event.
- Assessing long-term mortality risk post-STEMI is crucial for patient management.
- Existing methods may not fully capture the spectrum of myocardial injury severity.
Purpose of the Study:
- To evaluate a simple echocardiographic grading system for stratifying long-term mortality risk in first-time STEMI patients.
- To determine if this system reflects myocardial injury severity and stage.
- To assess its utility in clinical communication.
Main Methods:
- A multicentre prospective registry-based cohort study involving 2708 patients with first-time STEMI.
- Patients were stratified into four echocardiographic grades (1-4) post-discharge.
- Long-term all-cause mortality was the primary outcome, with a median follow-up of 5.5 years.
Main Results:
- Mortality risk increased stepwise with higher echocardiographic grades.
- Grade 4 was independently associated with significantly higher long-term mortality compared to Grade 1 (adjusted HR: 3.35).
- Comparable risk stratification was observed using 90-day echocardiographic data.
Conclusions:
- The echocardiographic grading system effectively stratifies long-term mortality risk after first-time STEMI.
- This simple, objective classification aids in communicating infarct severity beyond the general term 'myocardial infarction'.
- The system offers a practical tool for clinicians to assess and discuss prognosis.
Objectives:
To assess whether a simple echocardiographic grading system reflecting the severity and stage of myocardial injury can stratify long-term mortality risk among patients with first-time ST-segment elevation myocardial infarction (STEMI).
Design:
Multicentre prospective registry-based cohort study.
Setting:
Eight hospitals in China.
Participants:
Consecutive patients with first-time STEMI between June 2016 and June 2024 who survived to hospital discharge and underwent echocardiography were included. A total of 2708 patients were enrolled and followed up for a median of 5.5 years (IQR: 5.3-6.4).
Outcome Measures:
The primary outcome was long-term all-cause mortality.
Results:
Patients were stratified into four grades: 1392 (51.4%) were classified as Grade 1; 905 (33.4%) as Grade 2; 350 (12.9%) as Grade 3; and 61 (2.3%) as Grade 4. During follow-up, long-term all-cause mortality increased stepwise across increasing echocardiographic grades. In multivariable Cox regression analysis, the baseline grading remained an independent predictor of long-term mortality after adjustment (adjusted HR for Grade 4 vs Grade 1: 3.35, 95% CI 1.34 to 8.38, p<0.01). In a subset of patients with available 90-day echocardiographic data, the stratification yielded comparable group distributions and mortality trends to those observed with baseline data (adjusted HR for Grade 4 vs Grade 1: 6.22, 95% CI 1.69 to 22.82, p<0.01).
Conclusion:
Patient grade from the echocardiographic grading system was associated with long-term mortality after first-time STEMI, with the highest risk observed in patients classified as Grade 4. As a simple and objective classification, this grading system may provide a practical way to describe and communicate infarct severity among clinicians and others involved in patient care, as the term 'myocardial infarction' alone may inadequately reflect disease severity.
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