ST段抬高型心肌梗死（rise - stemi）患者射血收缩时间对心血管预后的影响

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-04-01 DOI:10.1016/j.cjco.2024.11.014

Tyler Szun BSc , Alexander Zaremba BSc , Aleksander Dokollari MD, PhD , Azin Khafipour MSc , Hilary Bews MD, FRCPC , Seth Cheung , James W. Tam MD, FRCPC , Shuangbo Liu MD, FRCPC , Derek So MD, FRCPC , Sean Van Diepen MD, FMSc , Ashish H. Shah MD, MD-Research, FRCP

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引用次数: 0

摘要

背景：尽管在血运重建、护理系统和二级预防治疗方面有所改善，但st段抬高型心肌梗死（STEMI）患者接受原发性经皮冠状动脉介入治疗（PPCI）的30天死亡率仍为4%至6%。本研究旨在探讨射血收缩期（EST）和射血收缩期（ESP）在鉴别STEMI高危患者中的应用价值。方法在这项回顾性研究中，纳入了2020年1月至2021年10月在三级心脏中心连续接受PPCI的STEMI患者。在MacLab上计算EST和ESP。采用单变量和多变量Cox回归分析确定风险预测因素。主要终点为30天死亡率。结果641例STEMI患者(平均年龄64.4±13.2岁；182/641例（28.4%）为女性患者。在30天内，32例（5.0%）患者死亡，且患者多为老年女性，既往卒中、慢性肾脏疾病和透析使用的发生率较高。30天内死亡的患者EST较低（0.20±0.04 vs 0.24±0.04秒/次）；P & lt;0.0001)和ESP（17.64±2.66 vs 19.29±2.74秒/分）；P = 0.004)。多变量建模后，只有EST是早期（30天）死亡率的显著预测因子(风险比4.5,95%置信区间1.7-12.1；P = 0.003)、住院时间延长（>；4天）、利尿剂使用、新诊断的心力衰竭、需要插管或通气、指数住院期间肌力和/或升压药物的使用。ESP和EST与30天至1年内的死亡率无关。结论低EST与30天死亡率和住院不良结局有关。EST可作为一种有用的血液动力学指标，对STEMI患者进行风险分层。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

CArdiovasculaR Outcomes Based Upon EjectIon Systolic TimE in Patients With ST Elevation Myocardial Infarction (ARISE-STEMI) Study

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CArdiovasculaR Outcomes Based Upon EjectIon Systolic TimE in Patients With ST Elevation Myocardial Infarction (ARISE-STEMI) Study

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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