Prevalence of severely impaired left ventricular ejection fraction after reperfused ST-elevation myocardial
David R Altmann1, Marcus Mutschelknauss, Niklas Ehl
1Departement of Cardiology, University of Basel Hospital, Switzerland; darobalt@gmail.com.
Insights
Preventive implantable cardioverter defibrillator (ICD) implantation after ST-segment elevation myocardial infarction (STEMI) may not be necessary. Early low left ventricular ejection fraction (LVEF) often recovers, suggesting an expectant approach before ICD consideration.
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- Preventive implantable cardioverter defibrillator (ICD) implantation after myocardial infarction (MI) in patients with depressed left ventricular ejection fraction (LVEF) has not shown survival benefits.
- Early recovery of LVEF after percutaneous coronary intervention (PCI) might explain these findings.
- This study investigates the incidence of sustained severely depressed LVEF after revascularized acute ST-segment elevation myocardial infarction (STEMI).
Purpose of the Study:
- To determine the incidence of sustained left ventricular ejection fraction (LVEF) ≤35% in patients with severely depressed LVEF early after acute ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI).
Main Methods:
- Left ventricular ejection fraction (LVEF) was assessed within 10 days (in-hospital) after acute ST-segment elevation myocardial infarction (STEMI) in patients treated with percutaneous coronary intervention (PCI).
- Patients with an in-hospital LVEF ≤35% underwent follow-up LVEF measurement within 6-8 weeks.
Main Results:
- Out of 330 patients, 10% (32/330) had an in-hospital LVEF ≤35% (measured 3 days post-STEMI).
- At follow-up (53 days post-STEMI), LVEF improved to >35% in 61% (19/31) of these patients.
- The incidence of persistently low LVEF (≤35%) at follow-up was 39% (12/31).
Conclusions:
- The incidence of severely impaired left ventricular function 53 days after STEMI treated with PCI is low.
- Only 39% of patients with early severely depressed LVEF after STEMI exhibit persistent impairment.
- These findings support an expectant management strategy before considering primary preventive ICD implantation post-STEMI.
Background:
Preventive implantation of an implantable cardioverter defibrillator (ICD) early after myocardial infarction failed to demonstrate a survival benefit in patients with depressed left ventricular ejection fraction (LVEF). This may be explained by early recovery of the LVEF after percutaneous coronary intervention (PCI). We sought to determine the incidence of a sustained LVEF ≤35% in patients with severely depressed LVEF early after a revascularised acute ST-segment elevation myocardial infarction (STEMI).
Methods:
LVEF was assessed in patients with an acute STEMI treated with PCI in two Swiss high-volume centres within 10 days (in-hospital LVEF) after the STEMI. Those with an in-hospital LVEF ≤35% were scheduled for follow-up LVEF measurement within 6-8 weeks.
Results:
A total of 330 patients were included (79% male, mean age 63 ± 12 years). In-hospital LVEF measured 3 ± 3 days after STEMI was ≤35% in 32/330 patients (10%, 95% confidence interval (CI) 13%-67%). LVEF was available in 31/32 (97%) patients at follow-up 53 ± 19 days after STEMI and improved to >35% in 19 patients (61%, 95% CI 42%-78%). The incidence of a LVEF ≤35% at follow-up was 39% (12/31, 95% CI 22%-56%).
Conclusion:
Our data demonstrate that the incidence of severely impaired LV function 53 ± 19 days after a STEMI treated with PCI is low. A severely depressed LVEF early after STEMI was present in 10% of all patients. Only 39% of these patients had a persistently impaired LVEF during follow-up. These findings support an expectant strategy before considering primary preventive ICD implantation after STEMI.
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