Prognostic impact of left ventricular ejection fraction recovery in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: analysis of an 11-year all-comers registry

• Published in: European heart journal. Acute cardiovascular care Vol. 10; no. 8; pp. 898 - 908
• Main Authors: Otero-García, Oscar, Cid-Álvarez, Ana Belén, Juskova, Mària, Álvarez-Álvarez, Belén, Tasende-Rey, Pablo, Gude-Sampedro, Francisco, García-Acuña, José María, Agra-Bermejo, Rosa, López-Otero, Diego, Sanmartín-Pena, Juan Carlos, Martínez-Monzonís, Amparo, Trillo-Nouche, Ramiro, González-Juanatey, José R
• Format: Journal Article
• Language: English
• Published: 27-10-2021
• ISSN: 2048-8726; 2048-8734
• DOI: 10.1093/ehjacc/zuab058

AIMSLeft ventricular ejection fraction (LVEF) recovery after an ST-segment elevation myocardial infarction (STEMI) identifies a group of patients with a better prognosis. However, the association between long-term outcomes and LVEF recovery among patients with STEMI undergoing primary percutaneous coronary intervention (PCI) has not yet been well investigated. Our study aims to detect differences in long-term all-cause and cardiovascular mortality between patients who recover LVEF at 1-year post-PCI and those who do not, and search for predictors of LVEF recovery. METHODS AND RESULTSThis is a retrospective, single-centre study of 2170 consecutive patients admitted for STEMI in which primary PCI is performed. LVEF was determined at admission and at 1-year follow-up. The primary outcomes were long-term all-cause and cardiovascular mortality. Among the 2168 patients with baseline LVEF data, 822 (38%) had a LVEF < 50% and 1346 (62%) ≥ 50%. Among those with LVEF < 50%, LVEF data at 1-year were available in 554, and 299 (54.0%) presented with complete recovery (LVEF ≥ 50%). LVEF recovery was associated with a reduction in long-term all-cause and cardiovascular mortality (P < 0.0001). Female sex, treatment with ACEIs, lower creatinine levels, infarct-related artery different from the left main or left anterior descendent artery, and absence of prior ischaemic heart disease were independently associated with LVEF recovery. CONCLUSIONSNearly 40% of patients with STEMI undergoing primary PCI presented with LVEF depression at hospital admission. Among them, LVEF recovery at 1-year occurred in more than 50% and was independently associated with a significant decrease in long-term all-cause and cardiovascular mortality.