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The relation between delayed reperfusion treatment and reduced left ventricular ejection fraction in patients with

Bård Uleberg1,2, Kaare Harald Bønaa3,4,5, Kari Krizak Halle5

  • 1Department of Community Medicine, UiT The Arctic University of Norway, Postboks 6050 Stakkevollan, 9037 Tromsø, Norway.

European Heart Journal Open
|April 17, 2025
PubMed

Insights

Delayed reperfusion in ST-segment elevation myocardial infarction (STEMI) significantly increases the risk of reduced left ventricular ejection fraction (LVEF). This nationwide study highlights the critical importance of timely treatment for better heart function outcomes.

Area of Science:

  • Cardiology
  • Cardiovascular Medicine
  • Interventional Cardiology

Background:

  • ST-segment elevation myocardial infarction (STEMI) is a critical condition requiring prompt treatment.
  • Left ventricular ejection fraction (LVEF) is a key indicator of heart function post-myocardial infarction.
  • The impact of reperfusion timing on LVEF requires further investigation in large patient cohorts.

Purpose of the Study:

  • To investigate the association between delayed reperfusion and reduced left ventricular ejection fraction (LVEF) in STEMI patients.
  • To quantify the risk of mildly to moderately reduced and severely reduced LVEF in relation to reperfusion delays.
  • To compare the effects of different reperfusion strategies on LVEF outcomes.

Main Methods:

  • A nationwide population-based cohort study including 6567 STEMI patients from 2015-2018.
  • Log-binominal and modified Poisson regression models were used to analyze associations.
  • Adjustments were made for reperfusion strategy and patient characteristics.

Main Results:

  • Delayed reperfusion (fibrinolysis > 30 min or primary PCI > 120 min) was associated with increased LVEF reduction.
  • The adjusted relative risk of mildly to moderately reduced LVEF was 1.11 (95% CI 1.04-1.18).
  • The adjusted relative risk of severely reduced LVEF was 1.76 (95% CI 1.37-2.25).

Conclusions:

  • Delayed reperfusion significantly increases the risk of both mildly to moderately reduced and severely reduced LVEF in STEMI patients.
  • The choice between primary percutaneous coronary intervention (pPCI) and pharmacoinvasive strategy (PI) did not significantly alter the risk of reduced LVEF.
Abstract

Keywords:
Acute myocardial infarction (AMI)FibrinolysisPCI

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