Outcomes for acute myocardial infarction with supranormal left ventricular ejection fraction

Despite cumulative evidence of superior outcomes for acute myocardial infarction (AMI) with normal left ventricular ejection fraction (LVEF) compared to those for AMI with reduced LVEF, real-world evidence on outcomes of patients with AMI and supranormal LVEF (snLVEF) is lacking. Therefore, this study aimed to evaluate the clinical outcomes of patients with AMI and snLVEF.

A total of 27,903 patients with AMI were included from the Korean nationwide AMI cohort between November 2011 and June 2020 after excluding those with unmeasurable LVEF. Patients were classified into four groups according to LVEF: supranormal (≥65%), normal (50%-64%), mid-range (40%-49%), and reduced (<40%). The primary outcome was 3-year all-cause mortality.

Across four hierarchical Cox models, snLVEF was consistently associated with lower 3-year all-cause mortality compared with normal LVEF (a crude model HR 0.71; 95% CI 0.58-0.87; a fully-adjusted model HR 0.77; 95% CI 0.60-0.98), with similar estimates observed in intermediate models.

Patients with AMI and snLVEF experienced the best clinical outcomes with the lowest mortality across the four groups.