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Evaluation of acute myocardial infarction patients with mid-range ejection fraction after emergency percutaneous
Yufeng Jiang1, Shengda Hu1, Mingqiang Cao1
1Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Insights
Patients with acute myocardial infarction (AMI) and mid-range ejection fraction (mrEF) have worse outcomes than those with preserved ejection fraction (pEF). This highlights the need for focused management strategies for mrEF patients post-emergency percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Clinical Medicine
- Heart Failure Research
Background:
- Acute myocardial infarction (AMI) lacks classification based on left ventricular ejection fraction (LVEF).
- Current understanding of outcomes across different LVEF categories in AMI patients undergoing emergency percutaneous coronary intervention (PCI) is limited.
Purpose of the Study:
- To compare clinical characteristics and in-hospital outcomes of AMI patients stratified by LVEF.
- To evaluate the impact of mid-range ejection fraction (mrEF), preserved ejection fraction (pEF), and reduced ejection fraction (rEF) on acute heart failure and mortality.
Main Methods:
- Retrospective analysis of 1270 patients undergoing emergency PCI.
- Stratification into pEF (LVEF ≥50%), mrEF (LVEF 40%-49%), and rEF (LVEF <40%) groups.
- Kaplan-Meier curves, log-rank tests, and Cox proportional hazards models were used.
Main Results:
- Reduced ejection fraction (rEF) independently increased risk of acute heart failure (HR 5.01) and all-cause mortality (HR 7.05) compared to mrEF.
- Preserved ejection fraction (pEF) independently protected against acute heart failure (HR 0.49) and all-cause mortality (HR 0.33) compared to mrEF.
- mrEF patients showed clinical similarities to pEF but had significantly worse prognosis.
Conclusions:
- Mid-range ejection fraction (mrEF) in AMI patients undergoing emergency PCI is associated with poorer prognosis than pEF.
- Urgent attention to the management of mrEF patients with AMI is warranted.
- LVEF stratification is crucial for understanding and managing AMI outcomes.
Background:
There is currently no classification for acute myocardial infarction (AMI) according to left ventricular ejection fraction (LVEF). We aimed to perform a retrospective analysis of patients undergoing emergency percutaneous coronary intervention (PCI), comparing the clinical characteristics, in-hospital acute heart failure and all-cause death events of AMI patients with mid-range ejection fraction (mrEF), preserved ejection fraction (pEF) and reduced ejection fraction (rEF).
Material And Methods:
Totally 1270 patients were stratified according to their LVEF immediately after emergency PCI into pEF group (LVEF 50% or higher), mrEF group (LVEF 40%-49%) and rEF group (LVEF <40%). Kaplan-Meier curves and log rank tests were used to assess the effects of mrEF, rEF and pEF on the occurrence of acute heart failure and all-cause death during hospitalisation. The Cox proportional hazards model was used for multivariate correction.
Results:
Compared with mrEF, rEF was an independent risk factor for acute heart failure events during hospitalisation (HR 5.01, 95% CI 3.53 to 7.11, p<0.001), and it was also an independent risk factor for all-cause mortality during hospitalisation (HR 7.05, 95% CI 4.12 to 12.1, p<0.001); Compared with mrEF, pEF was an independent protective factor for acute heart failure during hospitalisation (HR 0.49, 95% CI 0.30 to 0.82, p=0.01), and it was also an independent protective factor for all-cause death during hospitalisation (HR 0.33, 95% CI 0.11 to 0.96, p=0.04).
Conclusions:
mrEF patients with AMI undergoing emergency PCI share many similarities with pEF patients in terms of clinical features, but the prognosis is significantly worse than that of pEF patients, suggesting that we need to pay attention to the management of mrEF patients with AMI.
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