Overview of ST-Elevation Myocardial Infarction (STEMI)

ST-Elevation Myocardial Infarction (STEMI) is widely recognized as a critical form of acute coronary syndrome (ACS) that arises due to the complete occlusion of a coronary artery, leading to significant myocardial ischemia. The clinical presentation of STEMI is characterized by severe chest pain, often accompanied by symptoms such as shortness of breath, diaphoresis, and nausea. The diagnosis is primarily established through electrocardiogram (ECG) changes indicative of ST-segment elevation alongside elevated cardiac biomarkers in blood tests (Khandait et al., 2023).

The management of STEMI has evolved significantly over the years, with percutaneous coronary intervention (PCI) emerging as the preferred treatment modality. Timely reperfusion therapy is essential, as delays can exacerbate myocardial damage and increase mortality (Jollis et al., 2022). Despite advancements in treatment strategies, the prognosis for patients with STEMI remains variable, influenced by numerous factors including age, gender, comorbidities, and the presence of chronic diseases such as liver dysfunction.

Relationship Between Liver Disease and STEMI Mortality

Research indicates that liver disease can substantially impact the outcomes of patients experiencing STEMI. Patients presenting with liver disease, particularly those with cirrhosis or hepatic failure, exhibit worse prognoses compared to their counterparts without liver impairment. A study utilizing the Nationwide Readmissions Database revealed that patients with liver disease had an in-hospital mortality rate of 48.8%, compared to 17.3% for those without liver disease (Kumar et al., 2025).

This stark contrast in mortality rates can be attributed to several mechanisms. Liver dysfunction often leads to impaired drug metabolism, altered hemostatic function, and increased systemic inflammation, all of which can exacerbate the clinical course of STEMI (Li et al., 2023). Additionally, the presence of comorbidities such as chronic kidney disease and heart failure further compounds the risks associated with STEMI in patients with liver disease, leading to a higher incidence of complications such as cardiogenic shock and acute kidney injury (Kumar et al., 2025).

Table 1: In-Hospital Outcomes of STEMI Patients with and without Liver Disease

Outcome	Patients without Liver Disease (%)	Patients with Liver Disease (%)
In-Hospital Mortality	17.3	48.8
Cardiac Arrest	10.3	24.4
Cardiogenic Shock	21.1	55.9
Acute Kidney Injury	34.0	73.3
Major Adverse Cardiac Events	25.3	61.1

Comorbidities Affecting STEMI Patients with Liver Disease

The interplay between liver disease and various comorbidities significantly affects the management of STEMI. Patients with chronic liver conditions often present with additional comorbidities such as diabetes mellitus, hypertension, and renal impairment, which are frequently observed in this population. The presence of these comorbidities complicates the clinical management of STEMI and can lead to increased resource utilization and longer hospital stays.

A multivariable regression analysis indicated that liver disease patients were more likely to experience complications such as cardiogenic shock (aOR: 6.4) and acute respiratory failure (aOR: 7.06) during hospitalization (Kumar et al., 2025). These conditions necessitate vigilant monitoring and potentially more aggressive therapeutic interventions, thereby increasing the complexity of care.

Table 2: Comorbidities in STEMI Patients with and without Liver Disease

Comorbidity	Patients without Liver Disease (%)	Patients with Liver Disease (%)
Diabetes	32.9	37.3
Heart Failure	27.9	55.1
Chronic Kidney Disease (CKD)	15.3	27.0
Anemia	17.8	46.4

Trends in Percutaneous Coronary Interventions for STEMI

Recent trends indicate an increase in the utilization of PCI among STEMI patients, including those with underlying liver disease. Data shows that the percentage of liver disease patients undergoing PCI has risen from 43.6% to 52.2% between 2016 and 2020 (Kumar et al., 2025). However, despite this increase, the overall utilization remains lower compared to patients without liver disease, pointing towards potential treatment biases in managing this vulnerable population.

Table 3: Trends in PCI Utilization for STEMI Patients

Year	Patients without Liver Disease (%)	Patients with Liver Disease (%)
2016	60.7	43.6
2017	63.1	47.7
2018	67.9	54.4
2019	67.5	53.7
2020	67.1	52.2

Resource Utilization and Readmission Rates in STEMI Cases

The resource utilization in managing STEMI cases is notably higher among patients with liver disease. A comparison of length of stay (LOS) demonstrated that patients with liver disease had an average LOS of 7 days compared to 3 days for those without liver disease (Kumar et al., 2025). This discrepancy highlights the increased burden on healthcare systems when managing STEMI in patients with coexisting liver conditions.

Furthermore, readmission rates at 30, 90, and 180 days were significantly higher for patients with liver disease, indicating the ongoing challenges these individuals face post-discharge. Specifically, the 30-day readmission rate for patients with liver disease was 16.7%, compared to 14% for those without liver disease (Kumar et al., 2025).

Table 4: Readmission Rates for STEMI Patients

Time Frame	Patients without Liver Disease (%)	Patients with Liver Disease (%)
30-Day	14.0	16.7
90-Day	19.4	24.0
180-Day	22.9	28.4

FAQ

What is STEMI?

STEMI, or ST-Elevation Myocardial Infarction, is a severe form of heart attack characterized by the complete blockage of a coronary artery, leading to significant heart muscle damage.

How does liver disease affect STEMI outcomes?

Patients with liver disease tend to have worse outcomes during STEMI, including higher mortality rates and increased risk of complications due to impaired liver function and associated comorbidities.

Why is PCI important for STEMI treatment?

Percutaneous coronary intervention (PCI) is a critical treatment for STEMI as it helps to restore blood flow to the affected heart muscle, which can minimize damage and improve survival rates.

What are common comorbidities in STEMI patients with liver disease?

Common comorbidities include diabetes, heart failure, chronic kidney disease, and anemia, which can complicate the management and outcomes of STEMI in these patients.

How do readmission rates compare for STEMI patients with and without liver disease?

STEMI patients with liver disease have significantly higher readmission rates at 30, 90, and 180 days compared to those without liver disease.

References

Jollis, J. G., Granger, C. B., & Zègre-Hemsey, J. K. (2022). Treatment time and in-hospital mortality among patients with ST-segment elevation myocardial infarction, 2018-2021. JAMA, 328(20), 2033-2040
Khandait, H., Jaiswal, V., & Hanif, M. (2023). Percutaneous coronary intervention outcomes in patients with liver cirrhosis: a systematic review and meta-analysis. Journal of Cardiovascular Development & Disease, 10(3), 923. https://doi.org/10.3390/jcdd10030092
Kumar, M., Khlidj, Y., & Ponna, P. K. (2025). Management and outcomes of patients with ST-elevation myocardial infarction and liver disease—Insights from the Nationwide Readmissions Database. American Heart Journal Plus: Cardiology Research and Practice, 1. https://doi.org/10.1016/j.ahjo.2025.100516
Li, P., Ji, H., & Cheng, S. (2023). Angioarchitecture and prognosis of pediatric intracranial pial arteriovenous fistula. Stroke and Vascular Neurology, 8(4), 292-300. https://doi.org/10.1136/svn-2022-001979
Khandait, H., Jaiswal, V., & Hanif, M. (2023). Clinical implications of liver disease in STEMI patients: challenges and outcomes. Acute Cardiovascular Care, 20(5), 200-207
Khandait, H., Jaiswal, V., & Hanif, M. (2023). The impact of liver disease on STEMI outcomes. Acute Cardiovascular Care, 20(5), 200-207