Clinical and long-term prognostic trends in ST-segment elevation myocardial infarction: a multicentre national registry analysis

Abstract

Abstract Background Although significant advances in patient care, ST-segment elevation myocardial infarction (STEMI) remains a major health problem. Purpose To describe clinical and prognostic characteristics of Portuguese STEMI patients. Material and methods Retrospective multicentre analysis of STEMI patients included in the Portuguese Registry on Acute Coronary Syndromes (ProACS) between October 2010 and October 2022. Baseline characteristics, clinical findings, treatment and mortality were analyzed. Multivariate analysis was performed to assess predictors of mortality. Results The authors studied 14470 patients with a mean age of 64 ± 14 years, of which 74% were male. A high frequency cardiovascular risk factors was observed, namely high blood pressure (63%), dyslipidemia (54%), smoking (35%) and diabetes (25%). Previous myocardial infarction was present in 11%. The most common symptom was chest pain (94%), Killip class 1 the most frequent presentation and left ventricular ejection fraction was preserved in 52%. Around 88% of patients were submitted to coronary angiography and coronary angioplasty was successful in roughly 98%. Multivessel disease was found in 44% although left anterior descending artery was the most frequent culprit artery - in about 44% of cases. Regarding in-hospital complications: shock (36%), congestive heart failure (17%) and death (5%) were reported. Thirty-day and one-year mortality occurred in 6% and 8%, respectively. After multivariate analysis, older age (HR=4.06; CI 95% [2.556-6.448]; p<0.001), left ventricular ejection fraction under 30% (HR=2.038; CI 95% [1.284-3.234]; p=0.003) and Killip class above 1 (HR=1.578; CI 95% [1.104-2.256]; p=0.012) remained as independent risk factors for one-year mortality. Conclusions Cardiovascular risk factors were highly prevalent in our population. Although multivessel disease was common, the most frequent culprit artery was the left anterior descending artery with successful treatment. Several clinical characteristics, namely age, left ventricular ejection fraction and Killip class, were independent risk factors for one-year mortality.