The Long-term Prognostic Impact Of A Novel Post-Myocardial Infarction Stratification System And Medication Adherence Of Secondary Prevention On ST-Elevation Myocardial Infarction(STEMI) Patients:A Multi-Center Research

Background:In recent years,the treatment of acute ST-segment Elevation Myocardial Infarction（STEMI）patients has advanced significantly.Although some large-scale clinical research data have reflected the national average level of STEMI diagnosis and treatment,there is no such data in Shanghai.Meanwhile,the emergency system of STEMI in China still has a lot of room for improvement.Recently,a novel post-infarct myocardial infarction stratification has been proposed to evaluate myocardial damage,and its role in predicting short-term prognosis in STEMI patients has been confirmed.However,the value of this system in evaluating long-term prognosis is not clear.Currently,the focus of STEMI treatment has shifted from occlusive vessels to myocardial injury.A number of studies have shown that secondary prevention medication therapy is closely related to the prognosis of patients,but the patient’s adherence is still poor,and rare domestic research explored its potential factors.Methods:This study was a multi-center,prospective,registered clinical study that included 840 STEMI survivors from six hospitals in Shanghai in the past three years.The characteristics of diagnosis and treatment of STEMI patients in Shanghai were statistically analyzed.Based on the criteria for novel post-myocardial infarction stratification,study patients were grouped and the long-term prognosis,indicated as the incidence of Major Adverse Cardiovascular Events（MACEs,including all-cause death,reinfarction,stroke and heart failure）1 year after discharge were estimated.According to the patient’s 14^th day,90^th day,180^th day,and 360^th day follow-up medication information,the adherence to evidence-based secondary prevention medication therapy at and after discharge were described,whose related factors and influence on prognosis were further analyzed.Results:The study showed that the median visit time from symptoms onset for Shanghai STEMI patients was 3.5 hours,and the proportion of receiving PCI was93.6%,but the proportion of D2B time within 120 minutes was only 10%.According to the novel post-infarction stratification,the results showed that grade-3 was an independent predictor of MACEs within 1 year after discharge of STEMI patients（odds ratio[ORdds Ratio,OR]=2.943,95%confidence interval[Confidence Interval,CI]1.435-6.032）,suggesting long-term prognostic value.Follow-up of medication adherence found that patient’s adherence to medications presented with a decreased trend after discharge,and 180^th day low adherence was independently associated with1-year mortality（p=0.014）.In addition,age,hypertension,Killip class,inferior myocardial infarction and stent implantation during hospitalization were influencing factors of adherence to secondary prevention medication therapies.Conclusion:This study presents the treatment of STEMI patients in Shanghai in recent years,and provides clinic data for a reasonable assessment of the current medical level in China.The novel post-myocardial infarction stratification system has potential values in screening patients with heavy myocardial damage and predicting long-term prognosis of STEMI patients.Improving the adherence to secondary prevention medication therapies will help reduce the mortality.Paying attention to these factors influencing the adherence can improve existing rehabilitation management system and ultimately improve patient prognosis.