ST-elevation myocardial infarction with reduced left ventricular ejection fraction: Insights into persisting left ventricular dysfunction. A pPCI-registry analysis

- In pPCI era persistent LV dysfunction was observed in 28% of STEMI patients presenting with LVEF < 40%.
- LV recovery begins early post-PCI and should be hence reassessed before discharge.
- LV ejection fraction at discharge is the best indicator of late severe LV dysfunction persistence.
- Large myocardial infarction size and impaired renal function are also associated with LV remodeling.

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 (< 24 h post-pPCI, discharge and follow-up). Primary endpoint was LVEF ≤ 35% at follow-up. At a median time of 3 months, 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 6 days, 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.