Observational studyBMJ open2026
Echocardiographic grading for long-term mortality risk stratification after first-time ST-segment elevation myocardial infarction: a multicentre cohort study.
Observational study in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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19 authors.
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Abstract
objectivesTo 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).
designMulticentre prospective registry-based cohort study.
settingEight hospitals in China.
participantsConsecutive 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.
resultsPatients 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).
conclusionPatient 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.
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