Prognostic factors for mortality in ST-elevation myocardial infarction in individuals with diabetes: A systematic review with implications for risk stratification and therapeutic considerations.
Jul 2026· Pharmacology and Therapeutics· Vol 286, pp.
109083
· 0 citations· 112 references
Medicine
TL;DR
The need for therapeutic strategies beyond conventional risk factor modification, with emphasis on acute hemodynamic management, tailored pharmacotherapy, and optimized glycemic control in this high-risk population of individuals with established diabetes is highlighted.
Abstract
Standard modifiable cardiovascular risk factors (SMuRFs) and non-SMuRFs are commonly used for risk stratification and therapeutic guidance after ST-elevation myocardial infarction (STEMI) in the general population. Their prognostic relevance with a potential implication for pharmacological and therapeutic management in individuals with established diabetes remains uncertain. This systematic review with meta-analysis aimed to identify prognostic factors associated with mortality in individuals with diabetes and STEMI qualifying for potential therapeutic targets. Studies evaluating prognostic factors for mortality in individuals with diabetes after STEMI were included up to May 3, 2025. Data extraction was performed independently by two reviewers. Certainty of evidence (CoE) was evaluated (GRADE). Thirty-seven studies were included, of which 25 had a high risk of bias. Mortality after STEMI in individuals with diabetes was consistently associated with non-SMuRFs (age, female sex, chronic kidney disease), acute cardiac dysfunction (Killip class III-IV, heart failure, cardiogenic shock), and atherosclerosis extent (anterior infarction, prior myocardial infarction, peripheral vascular disease). Diabetes-specific risk factors, including glycemic control parameters and insulin treatment, were also associated with increased risk of mortality (low to very low CoE). Once diabetes is established, no increased risk of mortality was observed for traditional SMuRFs, such as hypertension, smoking status, dyslipidemia, and obesity. These findings highlight the need for therapeutic strategies beyond conventional risk factor modification, with emphasis on acute hemodynamic management, tailored pharmacotherapy, and optimized glycemic control in this high-risk population. REGISTRATION PROSPERo: CRD42022378193.
ABSTRACT Chagas cardiomyopathy is associated with a higher risk of severe cardiovascular events and increased mortality. Among the factors associated with Chagas cardiomyopathy, impairment in functional capacity-commonly assessed using the New York Heart Association (NYHA) functional classification-is notable and may contribute to risk stratification. In this review, we assessed the prognostic value of the NYHA classification on cardiovascular events and mortality in patients with Chagas cardiomyopathy. The search was performed across EMBASE, LILACS, MEDLINE, and Web of Science databases. Prospective and retrospective cohort studies in which the prognostic value of the NYHA classification was assessed were eligible. Risk of bias was assessed using the Quality in Prognostic Studies tool. Evidence was classified using the adapted GRADE system. Eighteen studies were included in the systematic review. The meta-analysis results indicate that the NYHA classification is an important prognostic factor for mortality. Patients with NYHA class III and IV showed a higher risk of death than those with class I and II (hazard ratio, 2.63; 95% confidence interval: 2.00-3.45; moderate GRADE evidence). Patients with NYHA class IV had a higher risk of death than those with class I, II, and III (hazard ratio, 2.80; 95% confidence interval: 1.06-7.43; low GRADE evidence). Very low evidence suggests that the NYHA classification does not predict heart transplantation or stroke, but may predict cardiac pacemaker implantation. Overall, the NYHA classification is a key prognostic indicator of mortality in Chagas cardiomyopathy, although its ability to predict stroke, heart transplantation, and pacemaker implantation is inconsistent.
W. Silva, Henrique Silveira Costa, H. J. Silva et al.· Revista da Sociedade Brasile...· 0 citations
The occurrence of NOAF was associated with increased in-hospital mortality, which was 2–3 times higher in patients with arrhythmia, and most NOAF prediction models developed specifically in STEMI cohorts undergoing PCI demonstrated higher discriminative ability.
R. L. Pak, B. I. Geltser, E. Kokarev et al.· Siberian Journal of Clinical...· 0 citations
Aims: ST-segment elevation myocardial infarction (STEMI) remains a major cause of morbidity and mortality despite advances in reperfusion strategies. Systemic inflammation plays a key role in the pathophysiology of acute myocardial infarction and may influence long-term outcomes. The Aggregate Index of Systemic Inflammation (AISI) is a novel composite biomarker reflecting overall inflammatory burden. However, its prognostic value in STEMI patients undergoing primary percutaneous coronary intervention (PCI) remains insufficiently explored.Methods: In this retrospective, single-center cohort study, a total of 1.224 patients with STEMI who underwent primary PCI between November 2022 and April 2025 were included. AISI was calculated using admission hematological parameters, and patients were stratified into tertiles. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of all-cause mortality, reinfarction, and repeat revascularization at 12 months. Cox proportional hazards models were used to identify independent predictors of MACE. Restricted cubic spline (RCS) analysis was performed to assess non-linear associations, and AISI was log-transformed for further modeling.Results: During a 12-month follow-up, the incidence of MACE increased significantly across AISI tertiles (14.2%, 16.7%, and 23.0%, respectively; p=0.003). In univariate analysis, higher AISI levels were associated with increased risk of MACE. In multivariable Cox regression analysis, AISI remained an independent predictor of MACE (HR: 1.001, 95% CI: 1.000-1.001, p=0.001). Restricted cubic spline (RCS) analysis demonstrated a non-linear association between AISI and MACE (p for non linearity
Ismail Balaban, Seda Tanyeri Uzel, B. Kültürsay et al.· Anatolian Current Medical Jo...· 0 citations
Objective: The Fibrosis-4 (FIB-4) index, derived from routine laboratory measurements, is a noninvasive marker increasingly linked to cardiovascular risk. However, its prognostic value in ST-segment elevation myocardial infarction (STEMI), particularly for composite outcomes, remains unclear. The objective of this study was to determine the independent predictive value of the FIB-4 index for 1-year major adverse cardiovascular events (MACE) in patients with STEMI.
Methods: In this retrospective observational study, 1110 consecutive patients with STEMI treated with primary percutaneous coronary intervention were enrolled. The FIB-4 index was calculated on admission, and patients were grouped into tertiles. The primary outcome was 1-year MACE, a composite of all-cause death, reinfarction, and repeat revascularization. The association between FIB-4 index and outcomes was assessed using multivariable Cox regression and restricted cubic spline modeling.
Results: One-year MACE occurred in 19.1% of the cohort. Event rates increased progressively across the FIB-4 tertiles (log-rank P < .001), with early and persistent divergence in Kaplan-Meier survival curves. In multivariable analysis, the FIB-4 index was independently associated with 1-year MACE; each 1-unit increment conferred an increased risk (HR, 2.02; 95% CI, 1.89-2.16; P < .001). Restricted cubic spline analysis demonstrated a nonlinear relationship, with risk rising more steeply at low-to-intermediate values before tapering at higher levels.
Conclusions: Among patients with STEMI, the FIB-4 index was independently associated with adverse outcomes. Because it is simple and readily obtainable, it may add value to early risk assessment, although its incremental benefit over established risk models warrants further study.
M. F. Keten, Kadir Bıyıklı, B. Kültürsay et al.· The European Research Journa...· 0 citations
Background: Acute kidney injury (AKI) is a significant complication among patients with heart failure with reduced ejection fraction (HFrEF). Once AKI occurs, therapeutic options are limited to supportive care, underscoring the clinical importance of early identification of patients at risk. This study sought to identify independent predictors of AKI development in geriatric HFrEF patients and subsequently establish a clinically applicable bedside risk quantification. Method: A total of 1,496 elderly patients (≥60 years) diagnosed with HFrEF at Guangdong Provincial People’s Hospital from January 2010 to December 2024 were enrolled according to predefined inclusion/exclusion criteria and stratified into an AKI group (n = 300) and a non-AKI group (n = 1196). Relevant parameters were screened using LASSO (Least Absolute Shrinkage and Selection Operator) regression, and risk factors for AKI in HFrEF patients were identified through univariate and multivariate logistic regression analyses. A nomogram was developed based on multivariate logistic regression results, accompanied by a corresponding heatmap. The predictive accuracy of the nomogram was evaluated using receiver operating characteristic (ROC) curves and calibration plots, while its clinical utility was demonstrated through decision curve analysis (DCA). Result: This study identified four independent predictors of AKI in patients with HFrEF, including N-terminal pro-B-type natriuretic peptide (NT-proBNP), uric acid (UA), CRP (C-reaction protein) and urea. A nomogram was developed based on these factors. The evaluation results demonstrated that the model exhibited good diagnostic accuracy, with an area under the receiver operating characteristic curve (AUC) of 0.721 (95% CI: 0.658–0.785). The calibration curve and DCA further indicated that the model possesses favorable clinical applicability. Conclusion: This study developed and validated a nomogram model for predicting AKI in patients with HFrEF. Clinicians can utilize this model to optimize clinical decision-making based on individualized patient characteristics, enabling personalized risk stratification for therapeutic interventions and prognostic evaluations.
Rui Yang, Qiqi Song, Haohan Ma et al.· Global Heart· 0 citations
INTRODUCTION
Cardiovascular risk-factor profiles among patients hospitalised with acute myocardial infarction (AMI) can inform surveillance of a high-risk clinical cohort, but do not directly represent risk-factor prevalence in the general population.
METHODS
We analysed aggregate annual Estonian AMI registry data for hospitalised AMI patients during 2015-2024. AMI04 risk-factor trends were assessed using ordinary least squares regression, with sensitivity analyses for known status, age-sex standardisation to the pooled hospitalised AMI cohort, COVID-period exclusion, AMI case mix, and national hospitalised AMI burden.
RESULTS
Documented smoking increased from 25.5% in 2015 to 28.1% in 2024 (β = 0.302% points/year; 95% CI 0.014 to 0.590; p = 0.042). The smoking trend remained significant in known-status analyses and after age-sex standardisation, although the crude observed trend became borderline after excluding 2020-2021. Documented dyslipidaemia increased descriptively, but full-period crude and age-sex-standardised trends were borderline, and unknown dyslipidaemia status decreased over time. Annual AMI attacks and national hospitalised AMI burden declined, with concurrent changes in sex and age composition.
CONCLUSION
Among hospitalised AMI patients in Estonia, documented smoking increased during 2015-2024 and remained consistent in known-status and age-sex-standardised sensitivity analyses. Dyslipidaemia trends require cautious interpretation because unknown status changed over time. These aggregate registry findings describe a selected hospitalised AMI cohort and should not be interpreted as direct evidence of national prevention-policy success or failure.
Abdulrahman Al-Dawoudi, Mujahed Dalain, D. Varlamov et al.· BMC Cardiovascular Disorders· 0 citations