ST-elevation myocardial infarction with reduced left ventricular ejection fraction: Insights into persisting left...

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Imaging

Background:

• Primary percutaneous coronary intervention (pPCI) significantly reduces left ventricular (LV) dysfunction post-ST-segment elevation myocardial infarction (STEMI).
• Early LV recovery is observed, but optimal timing for reassessment remains unclear.
• Predicting adverse LV remodeling is crucial for patient outcomes.

Purpose of the Study:

• To determine the proportion and timing of LV recovery in STEMI patients with initial LV dysfunction treated with pPCI.
• To identify early predictors of adverse LV remodeling.
• To evaluate the accuracy of LV ejection fraction (LVEF) assessment at different time points for predicting long-term outcomes.

Main Methods:

• Retrospective analysis of STEMI patients with LVEF ≤40% treated with pPCI (2007-2013).
• Inclusion of patients with LVEF assessments at <24h post-pPCI, discharge, and follow-up.
• Primary endpoint: LVEF ≤35% at 3-month follow-up. Analysis of predictors including creatinine, troponin I, and LVEF.

Main Results:

• At 3 months, 28% of patients (43/154) had LVEF ≤35%.
• Persistent LV dysfunction was associated with lower admission LVEF and less recovery during hospitalization.
• Independent predictors of 3-month LVEF ≤35% included admission creatinine, peak troponin I, and admission LVEF.
• LVEF at discharge (median 6 days) was more accurate (AUC 0.80) than admission LVEF (AUC 0.69) in predicting 3-month LV dysfunction (p=0.03).

Conclusions:

• Significant early LV recovery is common in STEMI patients with LV dysfunction treated with pPCI.
• LVEF assessment at discharge is a strong predictor of persistent severe LV dysfunction at 3 months.
• Discharge LVEF measurement is valuable for identifying patients who may benefit from further intervention or closer monitoring.