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Updated: May 31, 2025
Primary Outcome Assessment in a Pig Model of Acute Myocardial Infarction
Published on: October 14, 2016
Prolonged pain-to-balloon time still impairs midterm left ventricular function following STEMI
Dominik Felbel1, Sabrina Fackler2, Rachel Michalke2
1Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany. dominik.felbel@uniklinik-ulm.de.
Insights
Nearly half of ST-elevation myocardial infarction (STEMI) patients experience reduced left ventricular ejection fraction (LVEF) one year after treatment. Anterior STEMI and longer pain-to-balloon times predict long-term LVEF impairment, highlighting the need for faster reperfusion.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Medical Research
Background:
- ST-elevation myocardial infarction (STEMI) requires prompt reperfusion to mitigate long-term heart failure.
- Assessing left ventricular ejection fraction (LVEF) post-STEMI is crucial for predicting patient outcomes.
- This study examines LVEF in contemporary STEMI patients at a leading tertiary care center.
Purpose of the Study:
- To evaluate the proportion of STEMI patients with impaired LVEF at 1-year follow-up.
- To identify predictors of reduced LVEF in STEMI patients treated under current advanced healthcare standards.
- To understand the long-term impact of STEMI on cardiac function.
Main Methods:
- Analysis of 130 STEMI patients presenting for the first time with coronary artery disease.
- Left ventricular ejection fraction (LVEF) assessment via echocardiography at admission, discharge, and 1-year follow-up.
- Statistical analysis, including logistic regression, to determine independent predictors of reduced LVEF (<50%) at 1 year.
Main Results:
- At 1-year follow-up, 45% of STEMI patients exhibited reduced LVEF.
- Anterior wall myocardial infarction (OR 3.2) and increasing pain-to-balloon times (Q2: OR 15.7, Q4: OR 33.7) were independently associated with reduced LVEF.
- Initial LVEF was reduced in 94% of patients, decreasing to 69% at discharge and 45% at 1 year.
Conclusions:
- A significant proportion of STEMI patients have persistent LVEF reduction at 12 months despite optimal care.
- Pain-to-balloon times over 2 hours and anterior STEMI remain key predictors of long-term left ventricular dysfunction.
- Improving healthcare system efficiency and public awareness is vital to reduce treatment delays and enhance long-term STEMI outcomes.
Background:
ST-elevation myocardial infarction (STEMI) demands near-time reperfusion to reduce the risk of long-term heart failure. This study evaluates the proportion of impaired left ventricular ejection fraction (LVEF) following STEMI in the context of current healthcare settings at a tertiary care center equipped with the most advanced and up-to-date standards of care.
Methods:
Patients experiencing STEMI as their first manifestation of coronary artery disease were analyzed, as these individuals had no prior experience with heart-related chest pain. LVEF was assessed by levocardiography at admission and semiautomatically using TOMTEC in patients with eligible full-cycle echocardiography of 2- and 4-chamber view available at discharge and 1-year follow-up (FU). Pain-to-balloon time was divided into quartiles (Q) [0-111, 112-159, 160-246 and 247-784 min]. Multiple logistic regression analysis identified independent predictors of reduced LVEF < 50% at 1-year FU.
Results:
A total of 1,379 consecutive STEMI patients were reviewed from 2010 to 2017, with 130 meeting the inclusion criteria. Mean age was 63 ± 12 years, 75% were male, 14% had diabetes, 72% had arterial hypertension, and 56% had history of smoking. LVEF was reduced in 94% of patients at admission, 69% at discharge, and remained reduced in 45% at the 1-year follow-up. Anterior wall myocardial infarction (OR 3.2 [95%-CI 1.2-6.9], p = 0.018) and increasing pain-to-balloon time across quartiles (Q2: OR 15.7 [95%-CI 1.8-140.4], p = 0.014; Q4: OR 33.7 [3.4-278.7] p = 0.002) were independently associated with reduced LVEF at 1 year.
Conclusion:
Despite optimal medical management and advanced healthcare structures, nearly half of patients with STEMI as their first presentation of coronary artery disease continue to exhibit reduced LVEF at 12-months. Anterior wall myocardial infarction and pain-to-balloon time exceeding 2 h remain independent predictors of left ventricular dysfunction. Further improvements in healthcare systems and public education are essential to reduce treatment delays and improve long-term outcomes.
