title: ST-elevation myocardial infarction with reduced left ventricular ejection fraction: Insights into persisting left ventricular dysfunction. A pPCI-registry analysis.
abstract: Primary percutaneous coronary intervention (pPCI) largely reduced the rate of left ventricular (LV) dysfunction after ST-segment elevation acute myocardial infarction (STEMI). Though LV recovery begins early following revascularization, the optimal timing for re-assessment of LV function is still unclear. We sought to assess the proportion and timing of LV recovery in STEMI patients presenting with LV dysfunction treated by pPCI and to identify possible early predictors of adverse LV remodeling. STEMI patients with LV ejection fraction (LVEF ≤40%) at presentation treated by pPCI from 2007 to 2013 were included whether they had an available 3-step LVEF assessment (<24h post-pPCI, discharge and follow-up). Primary endpoint was LVEF ≤35% at follow-up. At a median time of 3months, 43 out of 154 patients (28%) had LVEF ≤35%. In patients with persistent LV dysfunction, LVEF was lower at admission and increased less during hospitalization (from 31±6 to 35±4% Vs 35±5 to 43±8% for patients with 3-months LVEF >35%, p<0.001). Independent predictors of 3-months LVEF ≤35% were creatinine at admission, peak troponin I and LVEF. Of note, LVEF re-assessment at discharge (median time 6days, IQR 4-9) showed an increased accuracy to predict 3-months LV dysfunction compared to LVEF at admission (AUC 0.80, 95% CI 0.72-0.88 vs AUC 0.69, 95% CI 0.58-0.79 respectively, p=0.03). In most of patients presenting with STEMI and LV dysfunction, a significant LV recovery can be observed early following pPCI. LVEF measurement at discharge indeed emerged as the best indicator of late persistence of severe LV dysfunction.
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti", University of Trieste, Trieste, Italy. Electronic address: davide.stolfo@gmail.com.
authors.forename: Davide
authors.initials: D
authors.lastname: Stolfo
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti", University of Trieste, Trieste, Italy.
authors.forename: Martino
authors.initials: M
authors.lastname: Cinquetti
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti", University of Trieste, Trieste, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Merlo
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti", University of Trieste, Trieste, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Santangelo
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti", University of Trieste, Trieste, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Barbati
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti", University of Trieste, Trieste, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Alonge
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti", University of Trieste, Trieste, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Vitrella
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti", University of Trieste, Trieste, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Rakar
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti", University of Trieste, Trieste, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Salvi
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti", University of Trieste, Trieste, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Perkan
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti", University of Trieste, Trieste, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Sinagra
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D020127:Recovery of Function; D000072657:ST Elevation Myocardial Infarction / Q000503:physiopathology / Q000601:surgery*; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000601:surgery*
keywords: Implantable cardioverter defibrillator; Left ventricular dysfunction; Myocardial infarction; Primary percutaneous coronary intervention; STEMI; Sudden cardiac death