Early Predictors of In-Hospital Mortality and Cardiac Dysfunction in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Early Revascularization.

Background

Despite advances in reperfusion therapy, ST-segment elevation myocardial infarction (STEMI) remains associated with substantial morbidity and mortality. Early identification of predictors of adverse outcomes is essential for improving risk stratification.

Methods

This retrospective study included 512 STEMI patients who underwent coronary revascularization within 6 h of symptom onset. Clinical, laboratory, angiographic and echocardiographic variables were analyzed. The primary endpoint was in-hospital mortality. Secondary outcomes included reduced left ventricular ejection fraction (LVEF < 40%) and moderate-to-severe ischemic mitral regurgitation (IMR). Independent predictors of in-hospital mortality were identified using multivariable logistic regression, while secondary outcomes were described to characterize the study population. Model performance was evaluated using ROC analysis.

Results

In-hospital mortality occurred in 9.4% of patients. Reduced LVEF was present in 26.2%, and IMR in 10.9%. Independent predictors of mortality included LVEF < 40% (OR 5.72, 95% CI 2.77-11.80, p < 0.001), IMR (OR 2.61, 95% CI 1.14-5.97, p = 0.023), lower hemoglobin levels (OR 0.74, 95% CI 0.61-0.91, p = 0.003), and reduced glomerular filtration rate (OR 0.96, 95% CI 0.95-0.98, p < 0.001). The model demonstrated good discrimination (AUC 0.88). Complete revascularization was not independently associated with mortality.

Conclusions

Left ventricular dysfunction, IMR, anemia, and renal impairment are strong predictors of in-hospital mortality in STEMI patients. Integrating echocardiographic and laboratory parameters may improve early risk stratification and guide clinical decision-making.