Change in Left Ventricular Ejection Fraction Following First Myocardial Infarction and Outcome.

Area of Science:

• Cardiology
• Cardiovascular Medicine
• Clinical Research

Background:

• Reduced left ventricular ejection fraction (LVEF) early after myocardial infarction (MI) indicates increased risk.
• The prognostic value of LVEF changes in the weeks to months following MI remains less certain.

Purpose of the Study:

• To investigate the association between LVEF recovery patterns and patient outcomes after a first MI.
• To determine if the degree of LVEF change post-MI provides additional prognostic information beyond early LVEF assessment.

Main Methods:

• Assessed LVEF change between early (2-7 days) and later (2-12 weeks) post-MI periods in three independent cohorts.
• Categorized patients into no recovery (Δ ≤0%), modest increase (Δ 1-9%), or large increase (Δ ≥10%) in LVEF.
• Utilized Cox multivariable models to analyze the relationship between LVEF change and risks of sudden cardiac arrest (SCA) and all-cause mortality.

Main Results:

• Patients with no LVEF recovery demonstrated a significantly higher risk of SCA (HR: 5.8) and death (HR: 3.9) compared to those with recovery, independent of other factors.
• These findings were consistent across all three independent cohorts (REFINE, CARISMA, ISAR).
• LVEF reassessments beyond 6 weeks post-MI were more predictive of outcomes than earlier assessments.

Conclusions:

• The extent of LVEF recovery after a first MI is a critical prognostic indicator.
• Patients exhibiting no LVEF recovery post-MI face a substantially elevated risk of sudden cardiac arrest and mortality.
• Late LVEF assessment (beyond 6 weeks) offers superior predictive value for adverse cardiovascular events.