Predictors and Clinical Implications of Left Ventricular Ejection Fraction Recovery Early After St-Elevation Myocardial Infarction

muhammad mahajna "Sackler" Faculty of Medicine, Tel-Aviv University, Tel-aviv, Israel Muhammad Mahajna "Sackler" Faculty of Medicine, Tel-Aviv University, Tel-aviv, Israel Alon Barsheshet Cardiology Department, Rabin Medical Center (Beilinson and Golda Hasharon Hospitals), petah tikva, Israel Hana Vaknin-Assa Cardiology Department, Rabin Medical Center (Beilinson and Golda Hasharon Hospitals), petah tikva, Israel Gabi Grinberg Cardiology Department, Rabin Medical Center (Beilinson and Golda Hasharon Hospitals), petah tikva, Israel Gregory Golovchiner Cardiology Department, Rabin Medical Center (Beilinson and Golda Hasharon Hospitals), petah tikva, Israel Alexander Omelchenko Cardiology Department, Rabin Medical Center (Beilinson and Golda Hasharon Hospitals), petah tikva, Israel Gustavo Goldenberg Cardiology Department, Rabin Medical Center (Beilinson and Golda Hasharon Hospitals), petah tikva, Israel Ehud Kadmon Cardiology Department, Rabin Medical Center (Beilinson and Golda Hasharon Hospitals), petah tikva, Israel Ran Kornowski Cardiology Department, Rabin Medical Center (Beilinson and Golda Hasharon Hospitals), petah tikva, Israel Abid Assali Cardiology Department, Rabin Medical Center (Beilinson and Golda Hasharon Hospitals), petah tikva, Israel

Background: Reduced left ventricular ejection fraction (LVEF<35%) after ST-elevation myocardial infarction (STEMI) is associated with increased mortality and if persists, may require an implantable cardioverter defibrillator (ICD) implantation.

Objectives: We aimed to evaluate clinical outcomes of STEMI patients with LVEF<35%, investigate changes in LVEF and variables associated with LV recovery early after STEMI.

Methods: 2277 medical records of patients with STEMI treated with primary percutaneous intervention were screened and analyzed for the presence of LVEF<35%. Patients with previous MI or presented with cardiogenic shock were excluded, 443 patients were included in the final analysis. Major improvement in LVEF from baseline up to 3-6 months follow up was defined as ∆LVEF ≥10 point. Independent predictors of major improvement in LVEF were determined utilizing logistic regression multivariable analysis.

Results: The mean baseline LVEF and after 3-6 months was 32±4%, and 41±10%, respectively (P<0.001). At 6 months, 62% of the subjects had LVEF≥35%; 43% had major improvement in LVEF (group I; n=190); 57% did not exhibit major improvement in LVEF (group II; n=253); 10% of the patients received an ICD. At 5 years, mortality rates were 8% vs. 17%, (P=0.004) for group I vs. II, and 17% among ICD recipients. By multivariable analysis, low peak CK levels, short time from chest pain to hospital admission, higher hemoglobin and glomerular filtration rate were independent predictors of major improvement in LVEF.

Conclusions: Among STEMI patients, 43% had significant improvement in LVEF. Myocardial recovery and ICD treatment (in patients without LV recovery) were associated with better clinical outcomes and lower mortality rates. Several predictors of LV recovery were identified in our study, potentially enabling improved risk stratification of STEMI patients with reduced LVEF.

muhammad mahajna