TEN-YEAR OUTCOMES AFTER ACUTE STEMI TREATED WITH PRIMARY PCI - THE ROLE OF ACUTE BIOMARKERS AND OTHER PARAMETERS IN PREDICTING CLINICAL SEVERITY AND PROGNOSIS.

Abstract

This rare prospective study investigated 10-year outcomes of acute ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI), and evaluated the role of acute biomarkers and other parameters in predicting clinical severity and prognosis. We included 250 patients and analyzed their baseline (cardiovascular risk factors), laboratory (maximal CK/TnT, acute inflammatory (white blood cells (WBC), hs-CRP), and liver biomarkers (AST/LDH), glomerular filtration rate (eGFR)) and clinical severity parameters (length of hospital stay, in-hospital complications, coronary angiography, and echocardiography (LVEF)). After hospital discharge, 229 patients were followed-up (2011-2022) and grouped according to the presence of major adverse cardiovascular events (MACE). In the acute phase, WBC, hs-CRP, LDH and AST positively correlated with maximal CK/cTnT and total in-hospital complications, and negatively with LVEF; WBC positively correlated with cardiogenic shock and stent diameter, hs-CRP with cardiac arrest and length of hospital stay, and LDH with stent diameter; total in-hospital complications increased the risk of in-hospital mortality and number of significantly stenosed coronary arteries, risk of heart failure, whereas the length of hospital stay negatively correlated with LVEF (p<0.05 all). During 10-year follow-up, LDH and clinical severity parameters (stenosis of LAD/ACx, multivessel CAD, proximal coronary stenosis, Gensini score, in-hospital complications) increased, while the others (normal eGFR and LVEF) reduced the risk of total MACE (p<0.05). In conclusion, acute biomarkers have a role in predicting clinical severity but they have no role in predicting long-term prognosis (except for LDH). Total in-hospital complications, more severe CAD, systolic dysfunction, and worse kidney function may lead to worse in-hospital and long-term outcomes.