{
  "abstract": "Objectives To assess whether a simple echocardiographic grading system reflecting the severity and stage of myocardial injury can stratify long-term mortality risk among patients with first-time ST-segment elevation myocardial infarction (STEMI).Design Multicentre prospective registry-based cohort study.Setting Eight hospitals in China.Participants Consecutive patients with first-time STEMI between June 2016 and June 2024 who survived to hospital discharge and underwent echocardiography were included. A total of 2708 patients were enrolled and followed up for a median of 5.5 years (IQR: 5.3–6.4).Outcome measures The primary outcome was long-term all-cause mortality.Results Patients were stratified into four grades: 1392 (51.4%) were classified as Grade 1; 905 (33.4%) as Grade 2; 350 (12.9%) as Grade 3; and 61 (2.3%) as Grade 4. During follow-up, long-term all-cause mortality increased stepwise across increasing echocardiographic grades. In multivariable Cox regression analysis, the baseline grading remained an independent predictor of long-term mortality after adjustment (adjusted HR for Grade 4 vs Grade 1: 3.35, 95% CI 1.34 to 8.38, p<0.01). In a subset of patients with available 90-day echocardiographic data, the stratification yielded comparable group distributions and mortality trends to those observed with baseline data (adjusted HR for Grade 4 vs Grade 1: 6.22, 95% CI 1.69 to 22.82, p<0.01).Conclusion Patient grade from the echocardiographic grading system was associated with long-term mortality after first-time STEMI, with the highest risk observed in patients classified as Grade 4. As a simple and objective classification, this grading system may provide a practical way to describe and communicate infarct severity among clinicians and others involved in patient care, as the term ‘myocardial infarction’ alone may inadequately reflect disease severity.",
  "authors": [
    {
      "affiliations": [
        "Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Yutong Miao"
    },
    {
      "affiliations": [
        "University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA"
      ],
      "name": "Lan Shen"
    },
    {
      "affiliations": [
        "Department of Geriatrics, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China"
      ],
      "name": "Li Wang"
    },
    {
      "affiliations": [
        "Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China"
      ],
      "name": "Jian-Fei Xiong"
    },
    {
      "affiliations": [
        "Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Yanqiao Lu"
    },
    {
      "affiliations": [
        "Department of Cardiology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China"
      ],
      "name": "Heng Ge"
    },
    {
      "affiliations": [
        "Department of Cardiology, Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China"
      ],
      "name": "Zongjun Liu"
    },
    {
      "affiliations": [
        "Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China"
      ],
      "name": "Ying Zhang"
    },
    {
      "affiliations": [
        "Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China"
      ],
      "name": "Xiang-Dong Xu"
    },
    {
      "affiliations": [
        "Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China"
      ],
      "name": "Wei Guo"
    },
    {
      "affiliations": [
        "Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Zhong Chen"
    },
    {
      "affiliations": [
        "Department of Cardiology, Shanghai Yangpu Hospital, Tongji University School of Medicine, Shanghai, China"
      ],
      "name": "Feng Su"
    },
    {
      "affiliations": [
        "Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China"
      ],
      "name": "Yan-song Li"
    },
    {
      "affiliations": [
        "Department of Cardiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China"
      ],
      "name": "Ning Zhou"
    },
    {
      "affiliations": [
        "Shanghai Xuhui Central Hospital, Shanghai, China"
      ],
      "name": "Xian Zhang"
    },
    {
      "affiliations": [
        "Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Ling-Hong Shen"
    },
    {
      "affiliations": [
        "Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Chang-qing Pan"
    },
    {
      "affiliations": [
        "University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA"
      ],
      "name": "Sidney Smith"
    },
    {
      "affiliations": [
        "Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China"
      ],
      "name": "Ben He"
    }
  ],
  "title": "Echocardiographic grading for long-term mortality risk stratification after first-time ST-segment elevation myocardial infarction: a multicentre cohort study",
  "uid": "6246c477-85dd-58fc-b098-386390445896"
}