Predictors of depressed left-ventricular ejection fraction after acute myocardial infarction
K M Eggers1, E Hamilton2, T Jernberg2
1Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
Insights
Impaired left-ventricular ejection fraction (LVEF) after myocardial infarction (MI) is linked to specific risk factors. Identifying these factors is crucial for targeted treatments to improve patient outcomes following MI.
Area of Science:
- Cardiology
- Clinical Research
- Public Health
Background:
- Impaired left-ventricular ejection fraction (LVEF) significantly predicts poor outcomes post-myocardial infarction (MI).
- Predisposing factors for reduced LVEF after MI remain incompletely understood.
- Understanding these factors is critical for developing effective interventions.
Purpose of the Study:
- To identify predisposing factors associated with impaired LVEF (<40%) in patients following ST-elevation MI (STEMI) and non-STEMI.
- To investigate the associations of cardiovascular risk factors, comorbidities, and angiographic features with reduced LVEF.
- To inform strategies for improving outcomes in MI patients.
Main Methods:
- A registry-based cohort study (SWEDEHEART) included 46,621 STEMI and 73,708 non-STEMI patients.
- Patients were admitted between 2010 and 2022, excluding those with prior heart failure.
- Multivariable logistic regression analyses were used to assess associations with LVEF <40%.
Main Results:
- Reduced LVEF (<40%) was observed in 47.6% of STEMI and 28.5% of non-STEMI patients.
- Anterior MI location was a strong predictor in STEMI; three-vessel/left main disease in non-STEMI.
- Independently associated factors with impaired LVEF included smoking, diabetes, underweight, kidney disease, and prior atherosclerotic disease; hypertension and overweight showed inverse associations.
Conclusions:
- Findings highlight the importance of early and complete revascularization for both STEMI and non-STEMI patients.
- Further research is needed to develop tailored cardioprotective pharmacotherapies for patients with identified risk factors and comorbidities.
- Addressing these factors can mitigate the risk of developing impaired LVEF after MI.
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
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