Szun Tyler, Zaremba Alexander, Dokollari Aleksander, Khafipour Azin, Bews Hilary, Cheung Seth, Tam James W, Liu Shuangbo, So Derek, Van Diepen Sean, Shah Ashish H
Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Section of Cardiac Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
CJC Open. 2024 Nov 26;7(4):516-524. doi: 10.1016/j.cjco.2024.11.014. eCollection 2025 Apr.
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.
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.
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; < 0.0001) and ESP (17.64 ± 2.66 vs 19.29 ± 2.74 seconds/min; = 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; = 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.
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.
尽管在血管重建、护理系统和二级预防治疗方面有所改善，但接受直接经皮冠状动脉介入治疗（PPCI）的ST段抬高型心肌梗死（STEMI）患者的30天死亡率仍为4%至6%。本研究旨在探讨射血收缩时间（EST）和射血收缩期（ESP）在识别高危STEMI患者中的作用。
在这项回顾性研究中，纳入了2020年1月至2021年10月期间在一家三级心脏中心接受PPCI的连续STEMI患者。EST和ESP在MacLab上计算。采用单变量和多变量Cox回归分析来识别风险预测因素。主要结局是30天死亡率。
招募了641例STEMI患者（平均年龄：64.4±13.2岁；182/641[28.4%]为女性患者）。在就诊后30天内，32例患者（5.0%）死亡，他们年龄更大、女性居多，既往中风、慢性肾病和透析使用率更高。30天内死亡的患者EST较低（0.20±0.04对0.24±0.04秒/搏；<0.0001），ESP也较低（17.64±2.66对19.29±2.74秒/分；=0.004）。经过多变量建模，只有EST是早期（<30天）死亡率的显著预测因素（风险比4.5，95%置信区间1.7 - 12.1；=0.003），住院时间延长（>4天）、使用利尿剂、新诊断为心力衰竭、需要插管或通气以及在本次住院期间使用血管活性药物和/或血管升压药。ESP和EST与30天至1年之间的死亡率无关。
较低的EST与30天死亡率和住院不良结局相关。EST可作为对STEMI患者进行风险分层的有用血流动力学标志物。
