Predictors of 1-Year Major Cardiovascular Events after ST-Elevation Myocardial Infarction in a Specialized Cardiovascular Center in Western Iran

Parisa Janjani; Sayeh Motevaseli; Nahid Salehi; Reza Heidari Moghadam; Soraya Siabani; Mahdi Nalini

doi:10.18502/jthc.v17i2.9839

Parisa Janjani Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Sayeh Motevaseli Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Nahid Salehi Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Reza Heidari Moghadam Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Soraya Siabani Department of Health Education and Health Promotion, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Mahdi Nalini Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.

DOI: https://doi.org/10.18502/jthc.v17i2.9839

Keywords: Myocardial infarction; Mortality; Morbidity; Risk factors; Stroke

Abstract

Background: Identifying the long-term predictors of recurrent cardiovascular events may help improve the quality of care and prevent subsequent events. We aimed to investigate the predictors of 1-year major cardiovascular events (MACE) in patients discharged after ST-elevation myocardial infarction (STEMI) in a tertiary hospital in Iran.

Methods: This registry-based cohort study included consecutive STEMI patients between 2016 and 2019 in Imam-Ali Hospital, Kermanshah, Iran. All patients discharged alive from STEMI hospitalization were followed up for 1 year for MACE, consisting of all-cause mortality, nonfatal MI, and nonfatal stroke. We estimated the hazard ratio (HR) and the 95% confidence interval (95% CI) using Cox proportional-hazard models to evaluate potential predictors, including demographic characteristics, medical history, cardiovascular risk factors, laboratory tests, reperfusion therapy, and medications.

Results: During 2187.2 person-years, 21 patients were lost to follow-up (success rate =99.1%). Of 2274 post-discharge STEMI patients (mean age =60.26 y; 21.9% female), 151 (6.6%) experienced MACE, including, all-cause mortality (n=115, 5.1%), nonfatal MI (n=20, 0.9%), and nonfatal stroke (n=16, 0.7%). Independent predictors of MACE were age (HR:1.02; 95% CI: 1.00–1.04), no education vs ≥12 years of formal schooling (HR: 2.07; 95% CI: 1.17–3.67), stroke history (HR: 2.37; 95% CI: 1.48–3.81), the glomerular filtration rate (HR: 0.98; 95% CI: 0.97–1.00), the body mass index (HR: 0.94; 95% CI:, 0.89–0.99), peak creatine kinase-MB (HR: 1.00; 95% CI: 1.00–1.002), thrombolysis vs primary percutaneous coronary intervention (HR: 1.85; 95% CI: 1.21–2.81), and left ventricular ejection fraction <35% vs ≥50% (HR: 2.82; 95% CI: 1.46–5.47).

Conclusion: Age, education, stroke history, the glomerular filtration rate, the body mass index, peak creatine kinase-MB, reperfusion therapy, and left ventricular function can be independently associated with 1-year MACE.