Left Ventricular Ejection Fraction Trajectory and Long-Term Outcomes Following Percutaneous Coronary Intervention for
Revathy Sampath-Kumar1, Sacharias von Koch2, Moman A Mohammad2
1UCSD Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, La Jolla, California, USA.
Insights
Left ventricular ejection fraction (LVEF) trajectory after myocardial infarction (MI) significantly impacts long-term outcomes. Even with LVEF recovery, patients face higher risks of heart failure hospitalization and mortality compared to those with preserved LVEF.
Area of Science:
- Cardiology
- Clinical Outcomes
- Echocardiography
Background:
- Limited data exist on left ventricular ejection fraction (LVEF) changes after myocardial infarction (MI).
- Understanding LVEF trajectory is crucial for predicting long-term prognosis post-MI.
Purpose of the Study:
- To assess the impact of LVEF trajectory following percutaneous coronary intervention (PCI) for MI on long-term outcomes.
- To analyze the association between different LVEF patterns and subsequent heart failure hospitalization and mortality.
Main Methods:
- Retrospective analysis of 13,439 patients undergoing PCI for MI between 2007-2022.
- Utilized serial echocardiograms from Swedish and UC San Diego registries.
- Assessed all-cause mortality and heart failure hospitalization within 6 years using time-to-event analysis.
Main Results:
- Four LVEF trajectories were identified: consistently reduced (redEF), recovered (recEF), consistently preserved (pEF), and decreased (decEF).
- Heart failure hospitalization rates were highest in redEF (40.0%) and decEF (30.4%), and mortality rates were highest in redEF (14.0%) and decEF (14.9%).
- Compared to pEF, redEF, decEF, and recEF groups showed significantly higher risks for both heart failure hospitalization and mortality.
Conclusions:
- LVEF trajectory after MI is a significant determinant of long-term patient outcomes.
- Even patients achieving LVEF recovery (recEF) experience increased risks for heart failure hospitalization and mortality.
- These findings highlight the importance of monitoring LVEF post-MI and considering trajectory in risk stratification.
Background:
Data are lacking on left ventricular ejection fraction (LVEF) trajectory following myocardial infarction (MI).
Objectives:
This study aimed to evaluate the impact of LVEF trajectory after percutaneous coronary intervention (PCI) for MI on long-term outcomes.
Methods:
Patients undergoing PCI for MI (2007-2022) with serial echocardiograms were identified in the Swedish Coronary Angiography and Angioplasty Registry and the UC San Diego internal National Cardiovascular Data Registry CathPCI Registry. All-cause mortality and heart failure hospitalization within 6 years were assessed with time-to-event analysis adjusted for baseline characteristics.
Results:
Of 13,439 patients (mean age 64 ± 10 years, 24.5% female, 46.8% ST-segment elevation MI), 28.2% had consistently reduced LVEF (redEF), 14.8% recovered their LVEF (recEF), 53.0% had consistently preserved LVEF (pEF), and 3.9% decreased from preserved to reduced LVEF (decEF). Heart failure hospitalization rates were 40.0% for redEF, 30.4% for decEF, 16.1% for recEF, and 6.4% for pEF (P < 0.001). Compared to pEF, the heart failure hospitalization risk was significantly higher for redEF (adjusted HR [aHR]: 8.49; 95% CI: 7.49-9.64; P < 0.001), decEF (aHR: 5.74; 95% CI: 4.69-7.02; P < 0.001), and recEF (aHR: 3.18; 95% CI: 2.70-3.76; P < 0.001). Mortality rates were 14.0% for redEF, 14.9% for decEF, 7.8% for recEF, and 6.7% for pEF (P < 0.001). Compared to pEF, the mortality risk was significantly higher for redEF (aHR: 2.20; 95% CI: 1.86-2.59; P < 0.001), decEF (aHR: 2.10; 95% CI: 1.56-2.82; P < 0.001), and recEF (aHR: 1.30; 95% CI: 1.02-1.65; P = 0.032).
Conclusions:
LVEF trajectory after MI significantly impacts long-term outcomes. Even patients with LVEF recovery remain at increased risk for heart failure hospitalization and mortality compared to those with pEF.
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