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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Effect of Guideline-Based Therapy on Left Ventricular Systolic Function Recovery After ST-Segment Elevation
Rachid Abou1, Melissa Leung1, Laurien Goedemans1
1Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Insights
In ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention, a baseline reduced left ventricular ejection fraction (LVEF) normalized in 39% of cases with optimal medical therapy. Smaller infarct size and absence of mitral regurgitation predicted LVEF recovery.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical condition requiring prompt intervention.
- Left ventricular ejection fraction (LVEF) is a key indicator of cardiac function post-myocardial infarction.
- Optimal medical therapy is crucial for recovery, but LVEF evolution in STEMI patients is not fully understood.
Purpose of the Study:
- To evaluate the proportion of STEMI patients with reduced baseline LVEF who achieve LVEF recovery.
- To assess LVEF changes over 6 months in STEMI patients treated with guideline-based medical therapy.
- To identify predictors of LVEF recovery in this patient cohort.
Main Methods:
- A cohort of 2,853 STEMI patients treated with primary percutaneous coronary intervention underwent echocardiography at baseline and 6-month follow-up.
- Patients with prior myocardial infarction, reinfarction, CABG, or incomplete data were excluded.
- Reduced LVEF was defined as <40%; recovery was defined as LVEF >50% at 6 months.
Main Results:
- The prevalence of baseline LVEF <40% was 13% (371 patients).
- At 6 months, 39% of patients with reduced baseline LVEF achieved LVEF >50%, 30% had LVEF 41-49%, and 31% remained <40%.
- Peak troponin T, baseline LVEF, and absence of mitral regurgitation were independent predictors of LVEF recovery.
Conclusions:
- A low proportion of STEMI patients present with significantly reduced LVEF at baseline.
- Optimal medical therapy leads to LVEF normalization in 39% of STEMI patients with baseline LVEF reduction.
- Predictors for LVEF recovery include smaller infarct size, better baseline LVEF, and absence of mitral regurgitation.
Abstract:
Little is known about the proportion of ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention, who have reduced left ventricular ejection fraction (LVEF) within 48 hours (baseline) of admission and exhibit LVEF recovery under optimal guideline-based medical treatment. Therefore, the present study evaluates the evolution of LVEF in patients after STEMI and under guideline-based medical therapy. In 2,853 STEMI patients treated with primary percutaneous coronary intervention, echocardiography was performed at baseline and at 6 months follow-up. Patients with previous myocardial infarction, reinfarction, coronary artery bypass grafting or incomplete echocardiographic data at 6 months follow-up were excluded. Reduced LVEF at baseline was defined as <40%. LVEF recovery was defined as LVEF >50% at 6 months follow-up. The prevalence of LVEF <40% at baseline was 13% (n = 371 patients; mean age 60 [range 33 to 88] years; 76% men). At follow-up, 31% of patients remained with a LVEF <40%, 30% showed a LVEF between 41% and 49% and in 39% of patients LVEF improved to >50%. There were no differences in usage of guideline-based medications at discharge across groups. On multivariable analysis, peak troponin T levels (odds ratio [OR] 0.895; p < 0.001), baseline LVEF (OR 1.069; p = 0.023) and absence of significant mitral regurgitation (OR 0.376; p = 0.018) were independently associated with LV recovery at follow-up. In conclusion, the prevalence of LVEF <40% is low. With optimal medical therapy, LVEF normalizes in 39% of patients. Smaller enzymatic infarct size, baseline LVEF and absence of mitral regurgitation were independently associated with LVEF recovery at follow-up.
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