Key result
Left ventricular ejection fraction <35% was the strongest independent predictor of 1-year major cardiovascular events among STEMI survivors, increasing the risk nearly 3-fold compared to LVEF ≥50% (HR 2.82).
Why the study?
Identifying long-term predictors of recurrent cardiovascular events may improve quality of care and prevent subsequent events in patients discharged after STEMI.
Cohort (n=2,274)
No
In patients discharged after STEMI, reduced LVEF, prior stroke, and receiving thrombolysis instead of primary PCI are strong independent predictors of 1-year MACE.
Answers are grounded in this paper and cite their sources.
Reduced LVEF and thrombolysis predict higher 1-year MACE post-STEMI; hypothesis-generating for risk stratification pending prospective validation.
Background: Identifying the long-term predictors of recurrent cardiovascular events may help improve the quality of care and prevent subsequent events. We aimed to investigate the predictors of 1-year major cardiovascular events (MACE) in patients discharged after ST-elevation myocardial infarction (STEMI) in a tertiary hospital in Iran. Methods: This registry-based cohort study included consecutive STEMI patients between 2016 and 2019 in Imam-Ali Hospital, Kermanshah, Iran. All patients discharged alive from STEMI hospitalization were followed up for 1 year for MACE, consisting of all-cause mortality, nonfatal MI, and nonfatal stroke. We estimated the hazard ratio (HR) and the 95% confidence interval (95% CI) using Cox proportional-hazard models to evaluate potential predictors, including demographic characteristics, medical history, cardiovascular risk factors, laboratory tests, reperfusion therapy, and medications. Results: During 2187.2 person-years, 21 patients were lost to follow-up (success rate =99.1%). Of 2274 post-discharge STEMI patients (mean age =60.26 y; 21.9% female), 151 (6.6%) experienced MACE, including, all-cause mortality (n=115, 5.1%), nonfatal MI (n=20, 0.9%), and nonfatal stroke (n=16, 0.7%). Independent predictors of MACE were age (HR:1.02; 95% CI: 1.00–1.04), no education vs ≥12 years of formal schooling (HR: 2.07; 95% CI: 1.17–3.67), stroke history (HR: 2.37; 95% CI: 1.48–3.81), the glomerular filtration rate (HR: 0.98; 95% CI: 0.97–1.00), the body mass index (HR: 0.94; 95% CI:, 0.89–0.99), peak creatine kinase-MB (HR: 1.00; 95% CI: 1.00–1.002), thrombolysis vs primary percutaneous coronary intervention (HR: 1.85; 95% CI: 1.21–2.81), and left ventricular ejection fraction <35% vs ≥50% (HR: 2.82; 95% CI: 1.46–5.47). Conclusion: Age, education, stroke history, the glomerular filtration rate, the body mass index, peak creatine kinase-MB, reperfusion therapy, and left ventricular function can be independently associated with 1-year MACE.
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Janjani et al. (2022) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=2,274). Left ventricular ejection fraction <35% vs. Left ventricular ejection fraction ≥50% was evaluated on 1-year major cardiovascular events (MACE), a composite of all-cause mortality, nonfatal MI, and nonfatal stroke (HR 2.82, 95% CI 1.46-5.47, p=0.002). Left ventricular ejection fraction <35% was the strongest independent predictor of 1-year major cardiovascular events among STEMI survivors, increasing the risk nearly 3-fold compared to LVEF ≥50% (HR 2.82).
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