Felbel Dominik, Fackler Sabrina, Michalke Rachel, Paukovitsch Michael, Gröger Matthias, Keßler Mirjam, Nita Nicoleta, Teumer Yannick, Schneider Leonhard, Imhof Armin, Buckert Dominik, Rottbauer Wolfgang, Markovic Sinisa
Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
BMC Cardiovasc Disord. 2025 Jan 23;25(1):37. doi: 10.1186/s12872-025-04484-3.
ST-elevation myocardial infarction (STEMI) demands near-time reperfusion to reduce the risk of long-term heart failure. This study evaluates the proportion of impaired left ventricular ejection fraction (LVEF) following STEMI in the context of current healthcare settings at a tertiary care center equipped with the most advanced and up-to-date standards of care.
Patients experiencing STEMI as their first manifestation of coronary artery disease were analyzed, as these individuals had no prior experience with heart-related chest pain. LVEF was assessed by levocardiography at admission and semiautomatically using TOMTEC in patients with eligible full-cycle echocardiography of 2- and 4-chamber view available at discharge and 1-year follow-up (FU). Pain-to-balloon time was divided into quartiles (Q) [0-111, 112-159, 160-246 and 247-784 min]. Multiple logistic regression analysis identified independent predictors of reduced LVEF < 50% at 1-year FU.
A total of 1,379 consecutive STEMI patients were reviewed from 2010 to 2017, with 130 meeting the inclusion criteria. Mean age was 63 ± 12 years, 75% were male, 14% had diabetes, 72% had arterial hypertension, and 56% had history of smoking. LVEF was reduced in 94% of patients at admission, 69% at discharge, and remained reduced in 45% at the 1-year follow-up. Anterior wall myocardial infarction (OR 3.2 [95%-CI 1.2-6.9], p = 0.018) and increasing pain-to-balloon time across quartiles (Q2: OR 15.7 [95%-CI 1.8-140.4], p = 0.014; Q4: OR 33.7 [3.4-278.7] p = 0.002) were independently associated with reduced LVEF at 1 year.
Despite optimal medical management and advanced healthcare structures, nearly half of patients with STEMI as their first presentation of coronary artery disease continue to exhibit reduced LVEF at 12-months. Anterior wall myocardial infarction and pain-to-balloon time exceeding 2 h remain independent predictors of left ventricular dysfunction. Further improvements in healthcare systems and public education are essential to reduce treatment delays and improve long-term outcomes.
ST段抬高型心肌梗死（STEMI）需要尽早进行再灌注治疗，以降低发生长期心力衰竭的风险。本研究评估了在配备最先进和最新护理标准的三级护理中心的当前医疗环境下，STEMI后左心室射血分数（LVEF）受损的比例。
分析首次发生STEMI作为冠状动脉疾病表现的患者，因为这些个体既往没有与心脏相关的胸痛经历。入院时通过心脏超声心动图评估LVEF，并在出院时和1年随访（FU）时，对有符合条件的2腔和4腔视图全周期超声心动图的患者使用TOMTEC半自动评估LVEF。疼痛至球囊扩张时间分为四分位数（Q）[0 - 111、112 - 159、160 - 246和247 - 784分钟]。多因素逻辑回归分析确定了1年随访时LVEF＜50%降低的独立预测因素。
2010年至2017年共回顾了1379例连续的STEMI患者，其中130例符合纳入标准。平均年龄为63±12岁，75%为男性，14%患有糖尿病，72%患有动脉高血压，56%有吸烟史。入院时94%的患者LVEF降低，出院时为69%，1年随访时仍有45%降低。前壁心肌梗死（比值比[OR]3.2[95%置信区间（CI）1.2 - 6.9]，p = 0.018）和四分位数间疼痛至球囊扩张时间增加（Q2：OR 15.7[95%CI 1.8 - 140.4]，p = 0.014；Q4：OR 33.7[3.4 - 278.7]，p = 0.002）与1年时LVEF降低独立相关。
尽管有最佳的药物治疗和先进的医疗结构，但近一半首次发生STEMI作为冠状动脉疾病表现的患者在12个月时LVEF仍持续降低。前壁心肌梗死和疼痛至球囊扩张时间超过2小时仍然是左心室功能障碍的独立预测因素。进一步改善医疗系统和公众教育对于减少治疗延迟和改善长期结局至关重要。
