Clinical, echocardiographic and angiographic predictors of early mortality in STEMI

Background

In-hospital mortality after ST-segment elevation myocardial infarction (STEMI) is a major determinant of early prognosis, despite substantial advances in coronary revascularization strategies. Early identification of patients at increased risk of death is essential for optimizing acute management and improving short-term outcomes. Echocardiographic and angiographic parameters may provide complementary prognostic information.

Purpose

To identify clinical, echocardiographic and angiographic predictors of in-hospital mortality in patients with STEMI treated by percutaneous coronary intervention.

Methods

We performed a retrospective observational study including 600 consecutive patients with STEMI undergoing primary percutaneous coronary intervention. Demographic characteristics, cardiovascular risk factors, and in-hospital outcomes were recorded. Echocardiographic assessment included parameters such as left ventricular ejection fraction (LVEF), the presence of severe mitral regurgitation or aortic stenosis, and pulmonary hypertension. Angiographic data focused on the presence and localization of significant and residual coronary artery lesions. In-hospital mortality was the primary endpoint. Independent predictors of mortality were identified using binomial logistic regression.

Results

Smoking status, sex, obesity and dyslipidemia were not significantly associated with early mortality, while diabetes mellitus showed a borderline association (OR 1.92, 95% CI 0.98–3.76, p=0.057).

Among echocardiographic parameters, pulmonary hypertension was strongly associated with in-hospital mortality (OR 4.61, 95% CI 2.41–8.83, p<0.001). Severe aortic stenosis was an independent predictor of early mortality (OR 4.89, 95% CI 1.57–15.24, p=0.006), while severe mitral regurgitation showed a borderline association (OR 1.92, 95% CI 0.94–3.92, p=0.073).

LVEF was independently associated with in-hospital mortality, each 1% increase in LVEF was associated with a 7% reduction in the odds of in-hospital mortality.

Angiographic findings showed a significant impact of lesion localization on in-hospital mortality. Left anterior descending artery involvement was associated with the highest risk of death (OR 4.07, 95% CI 1.92–8.62, p<0.001), followed by circumflex (OR 2.27, 95% CI 1.25–4.13, p=0.007) and right coronary artery lesions (OR 2.71, 95% CI 1.44–5.09, p=0.002). Residual coronary artery disease after revascularization was also associated with increased mortality, whereas door-to-balloon time was not.

Conclusions

In-hospital mortality in revascularized STEMI patients is predominantly driven by the severity of left ventricular dysfunction and by the extent and localization of coronary artery disease. Echocardiographic parameters, particularly LVEF and pulmonary hypertension, together with angiographic lesion distribution, provide valuable prognostic information and should be integrated into early risk stratification strategies in acute STEMI care.Angiographic lesions and early mortalityFor image description, please refer to the figure legend and surrounding text.Echo findings and early mortalityFor image description, please refer to the figure legend and surrounding text.