Reverse Left Ventricular Remodelling in ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous
Jeong Cheon Choe1, Kwang Soo Cha1, Eun Young Yun1
1Pusan National University Hospital, Busan, South Korea.
Insights
Reverse left ventricular remodelling (r-LVR) occurred in 38% of ST-elevation myocardial infarction patients post-primary percutaneous coronary intervention. This improvement in heart function was not linked to major adverse cardiac events during follow-up.
Area of Science:
- Cardiology
- Cardiovascular Research
- Interventional Cardiology
Background:
- Investigated reverse left ventricular remodelling (r-LVR) in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI).
- Defined r-LVR as a reduction of >10% in left ventricular end-systolic volume (LVESV) during follow-up.
Purpose of the Study:
- To identify predictors of r-LVR after PPCI in STEMI patients.
- To assess the association between r-LVR and clinical outcomes, specifically major adverse cardiac events (MACE).
Main Methods:
- 1,237 STEMI patients undergoing PPCI with baseline and 6-month echocardiography were analyzed.
- Patients were classified into r-LVR (n=466) and no r-LVR (n=771) groups.
- Propensity score matching was used to control for baseline differences; MACE (composite of death, MI, revascularization) was the primary outcome.
Main Results:
- r-LVR occurred in 37.7% of patients and was associated with initial left ventricular ejection fraction (LVEF) and LVESV after propensity score matching.
- During a median 403-day follow-up, 2-year MACE occurred in 13.4% of the cohort.
- MACE frequency and MACE-free survival were comparable between r-LVR and no r-LVR groups in both the entire cohort and PS-matched analysis.
Conclusions:
- Independent predictors of r-LVR were identified in STEMI patients treated with PPCI.
- Despite occurring in a significant proportion of patients, r-LVR was not associated with improved clinical outcomes (MACE).
Backgroud:
We investigated reverse left ventricular remodelling (r-LVR), defined as a reduction of >10% in left ventricular end-systolic volume (LVESV) during follow-up, in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI).
Methods:
STEMI patients (n=1,237) undergoing PPCI with echocardiography at baseline and 6-month follow-up were classified into r-LVR (n=466) and no r-LVR groups (n=771). The primary outcome was composite major adverse cardiac events (MACE; all-cause death, myocardial infarction, any revascularisation).
Results:
r-LVR occurred in 466 patients (37.7%) and was associated with maximum troponin, door-to-balloon time, direct arrival to PPCI-capable hospital, coronary disease extent, initial left ventricular ejection fraction (LVEF), and LVESV. After propensity score (PS)-matching, initial LVEF and LVESV remained significant. During a median 403-day follow-up, 2-year MACE occurred in 166 patients (13.4%); its frequency was similar between groups (entire cohort: 13.5% vs. 13.4%, p=0.247; PS-matched: 11.8% vs. 11.8%, p=0.987). Kaplan-Meier estimates showed that MACE-free survival was comparable between groups (entire cohort: 86.5% vs. 86.6%, log rank p=0.939; PS-matched: 88.2% vs. 88.2%, log rank p=0.867). In Cox proportional hazard analysis, r-LVR was not associated with MACE (entire cohort: hazard ratio [HR] 1.018, 95% confidential interval [CI] 0.675-1.534, p=0.934; PS-matched: HR 1.001, 95% CI 0.578-1.731, p=0.999).
Conclusion:
We identified independent predictors of r-LVR and showed that while r-LVR occurred in 38% of our patients, it was not associated with clinical outcomes.
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