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

Takeaway

• 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

• 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.

• Preserved EF (≥50%), mrEF (40-49%) and reduced EF (<40%) were identified in 281 (52.7%), 147 (27.6%) and 105 (19.7%) patients, respectively
• 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< 0.001 for all).
• 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.