Abstract
BackgroundThere is little evidence on left ventricular ejection fraction (LVEF) trajectories after ST-segment elevation myocardial infarction (STEMI).AimWe aim to identify the LVEF trajectories after STEMI and explore their predictors and association with prognosis.MethodsThis is a retrospective, observational study of STEMI patients. The LVEF trajectories were identified by the latent class trajectory model in patients with baseline LVEF < 50%. We used logistic regression analysis to investigate the predictors for LVEF trajectories. The Cox proportional hazard model was used to assess the impact of LVEF trajectories on prognosis. The primary outcomes were cardiovascular mortality and heart failure (HF) rehospitalization.Results572 of 1179 patients presented with baseline normal LVEF (≥ 50%) and 607 with baseline reduced LVEF (< 50%). Two distinct LVEF trajectories were identified in patients with baseline reduced LVEF: recovered LVEF group and persistently reduced LVEF group. Higher baseline LVEF, lower peak troponin T, non-anterior MI, and lower heart rates were all found to be independently associated with LVEF recovery. After multivariate adjustments, patients with persistently reduced LVEF experienced an increased risk of cardiovascular mortality (HR 7.49, 95% CI 1.94–28.87, P = 0.003) and HF rehospitalization (HR 3.54, 95% CI 1.56–8.06 P = 0.003) compared to patients with baseline normal LVEF. Patients with recovered LVEF, on the other hand, showed no significant risk of cardiovascular mortality and HF rehospitalization.ConclusionOur study indicated two distinct LVEF trajectories after STEMI and that the persistently reduced LVEF trajectory was related to poor prognosis. In addition, several baseline characteristics can predict LVEF recovery.
Highlights
Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of mortality and morbidity worldwide with an aging population
As illustrated in the locally weighted error sum of squares (Loess) curves (Fig. 2), 553 patients with a baseline reduced left ventricular ejection fraction (LVEF) were assigned into two different LVEF trajectories over a 3-year follow-up based upon the latent class trajectory model (LCTM)
hazard ratio (HR) hazards ratio, 95% CI 95% confidence interval, LVEF Left ventricular ejection fraction, HF heart failure, percutaneous coronary intervention (PCI) Percutaneous coronary intervention, SBP Systolic blood pressure, intra-aortic balloon pump (IABP) Intra-aortic balloon pump, TIMI Thrombolysis in Myocardial Infarction, angiotensin-converting enzyme inhibitors (ACEIs) Angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers (ARBs) Angiotensin II receptor blockers recovery and 54.1% suffering persistent LVEF reduction
Summary
Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of mortality and morbidity worldwide with an aging population. There is a lack of study on the LVEF trajectories in STEMI patients undergoing primary percutaneous coronary intervention (PCI). Given this knowledge gap, this study aimed to identify the LVEF trajectories over a 3-year follow-up among STEMI patients undergoing primary PCI and explore their predictors and association with long-term cardiovascular mortality and HF rehospitalization. There is little evidence on left ventricular ejection fraction (LVEF) trajectories after ST-segment elevation myocardial infarction (STEMI). Patients with persistently reduced LVEF experienced an increased risk of cardiovascular mortality (HR 7.49, 95% CI 1.94–28.87, P = 0.003) and HF rehospitalization (HR 3.54, 95% CI 1.56–8.06 P = 0.003) compared to patients with baseline normal LVEF.
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