Key result
Lower ejection systolic time was a significant independent predictor of 30-day mortality in patients with STEMI undergoing primary PCI.
Why the study?
Despite advances in care, 30-day mortality in STEMI undergoing PPCI remains 4% to 6%, prompting investigation into the utility of ejection systolic time and ejection systolic period for risk stratification.
Does measurement of ejection systolic time (EST) improve risk stratification for 30-day mortality in STEMI patients undergoing primary PCI?
Cohort (n=641)
No
Does measurement of ejection systolic time (EST) improve risk stratification for 30-day mortality in STEMI patients undergoing primary PCI?
Answers are grounded in this paper and cite their sources.
A lower ejection systolic time (EST) is a significant independent predictor of 30-day mortality and in-hospital adverse outcomes in STEMI patients undergoing primary PCI.
Background Despite improvements in revascularization, systems of care, and secondary prevention therapies, 30-day mortality rates in patients presenting with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) remains 4% to 6%. This study aims to investigate the utility of the ejection systolic time (EST) and ejection systolic period (ESP) in identifying high-risk STEMI patients. Methods In this retrospective study, consecutive patients with STEMI undergoing PPCI at a tertiary cardiac center between January 2020 and October 2021 were included. EST and ESP were calculated on the MacLab. Univariable and multivariable Cox regression analysis were used to identify risk predictors. The primary outcome was mortality at 30 days. Results Six hundred forty-one STEMI patients (mean age: 64.4 ± 13.2 years; 182/641 [28.4%] female patients) were recruited. Within 30 days of presentation, 32 patients (5.0%) died, and they were more frequently older, female, and had higher rates of previous stroke, chronic kidney disease, and dialysis use. Patients dying within 30 days had lower EST (0.20 ± 0.04 vs 0.24 ± 0.04 seconds/beat; P < 0.0001) and ESP (17.64 ± 2.66 vs 19.29 ± 2.74 seconds/min; P = 0.004). After multivariable modeling, only EST was a significant predictor of early (<30 days) mortality (hazard ratio 4.5, 95% confidence interval 1.7-12.1; P = 0.003), prolonged in-hospital stay (>4 days), diuretic use, new diagnosis of heart failure, need for intubation or ventilation, and inotrope and/or vasopressor use during the index hospital admission. ESP and EST were not associated with the mortality between 30 days and 1 year. Conclusions A lower EST was associated with mortality at 30 days and in-hospital adverse outcomes. EST may serve as a useful hemodynamic marker to risk-stratify STEMI patients.
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Szun et al. (2024) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=641). Ejection systolic time (EST) was evaluated on Mortality at 30 days (HR 4.5, 95% CI 1.7-12.1, p=0.003). Lower ejection systolic time was a significant independent predictor of 30-day mortality in patients with STEMI undergoing primary PCI.
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