Predictors of depressed left-ventricular ejection fraction after acute myocardial infarction

Impairment of left-ventricular ejection fraction (LVEF) is a major determinant of poor outcome after myocardial infarction (MI). Data on predisposing factors is however, scarce.

Registry-based cohort study (SWEDEHEART) investigating 46,621 ST-elevation MI (STEMI) patients and 73,708 non-STEMI patients without a history of heart failure, admitted between 2010 and 2022. Associations of cardiovascular risk factors, comorbidities and angiographic features with LVEF <40 % were studied using multivariable logistic regressions.

LVEF <0.40 was noted in 23,165 (47.6 %) STEMI patients and in 20,978 (28.5 %) non-STEMI patients. In minimally adjusted models, anterior MI localization emerged as the strongest predictor of LVEF <0.40 in STEMI (OR 4.32 [95 % CI 4.07-4.59]) while three-vessel disease/left main stenosis was one of the strongest predictors in non-STEMI (OR 1.78 [95 % CI 1.67-1.90]). Following full adjustment including angiographic data, smoking, diabetes, underweight, kidney disease and estimates of preexisting atherosclerotic disease (previous MI, previous stroke, peripheral artery disease) were independently associated with LVEF <0.40 in both MI types. Hypertension and overweight exhibited inverse associations with LVEF <0.40.

Our results emphasize the need of early and complete revascularization in STEMI and non-STEMI, respectively, and of further investigation to inform customized cardioprotective pharmacotherapies in patients with concomitant risk factors and comorbidities, given their risk of developing impaired LVEF.