Navigating the Risk Landscape in ST-Elevation Myocardial Infarction Patients Postpercutaneous Coronary Intervention: A Narrative Review

Abstract

The ST-Elevation Myocardial Infarction (STEMI) remains one of the major contributors to death and disability worldwide. The primary Percutaneous Coronary Intervention (pPCI) has gained wide adoption as the preferred reperfusion strategy over time. The present narrative discussion highlights a wide range of factors that can confer mortality in patients with STEMI treated with PCI, focusing strongly on demographic variables and clinical presentation issues that present inherent challenges to treatment strategies. Age stands out as a predictor of poor outcomes, with the worst prognoses found in those older than 80 years. In this population, diabetes mellitus, hypertension, and reduced cardiac function all dramatically increase the risk of poor outcomes. The presence of cardiogenic shock is another prime determinant of mortality and often multiplies these risks when combined with multivessel Coronary Artery Disease (CAD) and delayed initiation of treatment. Other notable risks post-PCI include repeated myocardial infarction, arrhythmias, and in-stent thrombosis, each of which further complicates clinical management. All these factors together create a complex, high-risk profile of patients who will need individualised and directed management strategies for optimum reduction in mortality. Delays in door-to-balloon times continue to be a major challenge to achieving better outcomes in regions with limited resources. Additionally, a significant long-term challenge is the management of multivessel disease and personalised therapy for high-risk patients, particularly during the acute phase. While PCI has resulted in a substantial reduction in mortality among patients with STEMI, gaps in outcomes still exist, predominantly among older patients and those with a greater complexity of co-morbidities. Treatment protocols must be continuously refined to address these gaps. The paper underscores the need for continuous innovation and research at both pre-hospital and post-PCI management levels to reduce mortality rates and improve the long-term outcomes of high-risk STEMI patients.

Keywords

• acute coronary syndrome
• door-to-balloon time
• multivessel coronary artery diseases
• personalised therapy