Impact of mid-range ejection fraction on clinical outcomes in STEMI

  • Alkhalil M & al.
  • Int J Cardiol
  • 15 Jul 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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  • Patients presenting with mid-range ejection fraction (mrEF) following ST-segment elevation myocardial infarction (STEMI) were at an increased risk of death, heart failure hospitalisation and ventricular arrhythmias vs those with preserved EF over long-term follow-up.
  • Suboptimal medical therapy in mrEF was linked to increased adverse clinical outcomes, particularly in patients with renal dysfunction

Why this matters

  • Findings support the need for dedicated clinical pathways to manage patients with mrEF after STEMI.

Study design

  • A retrospective analysis of 533 patients with STEMI who underwent primary percutaneous coronary intervention (PCI).
  • Primary endpoint: composite of death, re-admission with heart failure, sustained ventricular arrhythmia requiring hospitalisation or implantable cardioverter defibrillator over 3 years follow-up.
  • Funding: None.

Key results

  • Preserved EF (≥50%), mrEF (40-49%) and reduced EF (
  • A stepwise increase was noted in the primary endpoint according to EF category: preserved EF (8%); mid-range EF (17%); and reduced EF (30%; P<.001>
  • The risk was significantly higher with mrEF vs preserved EF (HR, 4.08; 95% CI, 2.38-6.99; P<.001>
  • Suboptimal medical therapy was associated with an increased future risk in patients with mrEF (HR, 2.62; 95% CI, 1.18-5.83; P=.018).
  • The proportion of patients with mrEF who experienced the primary endpoint was significantly different according to the kidney function status and recommended medical therapy:
    • 8% (preserved renal function on recommended therapy);
    • 20% (preserved renal function with suboptimal therapy);
    • 33% (abnormal renal function on recommended therapy); and
    • 50% (abnormal renal function with suboptimal therapy; P
  • Patients with mrEF and abnormal renal function receiving suboptimal therapy had an increased risk vs those with preserved renal function receiving recommended therapy (HR, 8.44; 95% CI, 2.83-25.18; P<.001>


  • Retrospective design.