Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Nov 29;10(23):5634.
doi: 10.3390/jcm10235634.

Predictors of Mortality and Long-Term Outcome in Patients with Anterior STEMI: Results from a Single Center Study

Giulia Ferrante  1 , Lucia Barbieri  2 , Carlo Sponzilli  1 , Stefano Lucreziotti  1 , Diego Salerno Uriarte  1 , Marco Centola  1 , Monica Verdoia  3 , Stefano Carugo  2
Affiliations

Predictors of Mortality and Long-Term Outcome in Patients with Anterior STEMI: Results from a Single Center Study

Giulia Ferrante et al. J Clin Med. .

Abstract

Anterior ST segment elevation myocardial infarction (A-STEMI) has the worst prognosis among all infarct sites due to larger infarct size and the higher cardiac enzyme release. We retrospectively analyzed 584 A-STEMI undergoing urgent coronary angiography from October 2008 to April 2019. The median follow-up time was 1774 days with a minimum of a 1-year follow-up for 498 patients. In-hospital mortality was 8.6%, while long-term, all-cause mortality and 1-year mortality were 18.8% and 6.8%, respectively. The main predictors for in-hospital mortality were ejection fraction (LV-EF), baseline estimated glomerular filtration rate (eGFR), female gender and cardiogenic shock (CS) at admission, while long-term predictors of mortality were age, coronary artery disease (CAD) extension and LV-EF. Patients presenting with CS (6.5%) showed a higher mortality rate (in-hospital 68.4%, long term 41.7%). Among 245 patients (42%) with multivessel disease (MVD), complete revascularization (CR) during the index procedure was performed in 42.8% of patients and more often in patients with CS at admission (19.1% vs. 6.1%, p = 0.008). Short- and long-term mortality were not significantly influenced by the revascularization strategy (CR/culprit only). Our study confirmed the extreme fragility of A-STEMI patients, especially in case of CS at admission. LV-EF is a powerful predictor of a poor outcome. In MVD, CR during p-PCI did not show any advantage for either long- or short-term mortality compared to the culprit-only strategy.

Keywords: STEMI; cardiogenic shock; complete revascularization; multivessel disease.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Overall survival at maximum follow-up in the total cohort of patients.
Figure 2
Figure 2
Kaplan–Meier curves for mortality rate according to the presence of cardiogenic shock at admission.
Figure 3
Figure 3
Kaplan–Meier curves for mortality rate in multivessel coronary artery disease group according to PCI strategy.
See this image and copyright information in PMC

References

    1. Gershlick A.H., Khan J.N., Kelly D.J., Greenwood J.P., Sasikaran T., Curzen N., Blackman D.J., Dalby M., Fairbrother K.L., Banya W., et al. Randomized trial of complete versus lesion-only revascularization in patients undergoing primary percutaneous coro-nary intervention for STEMI and multivessel disease: The CvLPRIT trial. J. Am. Coll. Cardiol. 2015;65:963–972. doi: 10.1016/j.jacc.2014.12.038. - DOI - PMC - PubMed
    1. Park D.-W., Clare R.M., Schulte P.J., Pieper K.S., Shaw L.K., Califf R.M., Ohman E.M., Van De Werf F., Hirji S., Harrington R.A., et al. Extent, location, and clinical significance of non-infarct related coronary artery disease among patients with ST-elevation myocardial infarction. JAMA. 2014;312:2019–2027. doi: 10.1001/jama.2014.15095. - DOI - PubMed
    1. Sehti A., Bahekar A., Bhuriya R., Singh S., Ahmed A., Khosla S. Complete versus culprit only revascularization in acute ST elevation myocardial infarction: A meta-analysis. Catheter. Cardiovasc. Interv. 2011;77:163–170. - PubMed
    1. Hlinomaz O., Groch L., Polokova K., Lehar F., Vekov T., Petkov R., Stoynev M., Griva M., Sitar J., Rezek M. Multivessel Coronary Disease Diagnosed at the Time of Primary PCI for STEMI: Complete Revascularization versus Conservative Strategy. PRAGUE 13 Trial. In EuroPCR 2015. [(accessed on 17 April 2020)]. Available online: https://media.pcronline.com/diapos/EuroPCR2015/2173-20150519_1445_Main_A....
    1. Kornowski R., Mehran R., Dangas G., Nikolsky E., Assali A., Claessen B.E., Gersh B.J., Wong S.C., Witzenbichler B., Guagliumi G., et al. Prognostic impact of staged versus “one-time” multivessel percutaneous intervention in acute myocardial infarction: Analysis from the HORIZONS-AMI (harmonizing outcomes with revascularization and stents in acute myocardial infarction) trial. J. Am. Coll. Cardiol. 2011;58:704–711. doi: 10.1016/j.jacc.2011.02.071. - DOI - PubMed