Abstract
BACKGROUND: ST-elevation myocardial infarction (STEMI) remains a significant global health concern, especially in low- and middle-income regions. This study aimed to identify long-term prognostic factors among STEMI patients, offering insights into improving patient outcomes. MATERIALS AND METHODS: This study represents the 5-year follow-up of STEMI patients in the SEMI Cohort in Isfahan registry, a clinical-based registry of STEMI patients in Isfahan, Iran, from October 2015. All patients with STEMI within 24 h of symptom onset underwent a comprehensive evaluation. The dataset included demographic information, laboratory data, medical history, and clinical in-hospital data. Over 5 years, annual follow-ups were conducted to track hospitalization and patient all-cause mortality. Utilizing univariate and multivariate Cox regression proportional hazard modeling, we aimed to identify predictors of death. RESULTS: In this study, involving 759 patients (621 men and 138 women) with a mean age of 58.92 ± 11.79 years, 158 deaths (21%) with a mean age of 70.33 ± 12.66 years occurred after STEMI. In the multiple model our analysis revealed that the following variables significantly increased all-cause mortality independently: Older age (hazard ratio [HR]: 1.070, P < 0.001), lower body mass index (HR: 0.890, P < 0.001), hypertension status (HR: 2.441, P < 0.001), lower systolic blood pressure at initial presentation (HR: 0.983, P < 0.001), number of affected epicardial territories (HR: 2.979, P < 0.001), lower last ejection fraction before discharge (HR: 0.951, P < 0.001), lower hemoglobin level (HR: 0.747, <0.001), higher plasma glucose level (HR: 1.005, P < 0.001), and in-hospital complications (HR: 7.646, P < 0.001). CONCLUSION: This study identified a range of factors that predict STEMI-related mortality. These findings are pivotal for future planning and decision-making regarding appropriate diagnostic and therapeutic strategies during patient follow-up, contributing to improved outcomes in STEMI care.