• NEWS . 31 Aug 2020
  • Mid-range ejection fraction in STEMI patients linked to higher adverse outcomes

  • Evidence is sparse on the impact of mid-range ejection fraction (mrEF) on clinical outcomes including ventricular arrhythmias and in ST-segment-elevation myocardial infarction (STEMI). Therefore, a study was carried out to evaluate the prognostic role of mrEF post STEMI and whether the recommended medical therapy can modify future risk. 

    A total of 533 consecutive patients who underwent primary percutaneous coronary intervention were included. Reduced EF (<40%), mrEF (40–49%) and preserved EF (≥50%) were defined based on the European Society of Cardiology guidelines. The primary endpoint included the composite of death, re-admission with heart failure, sustained ventricular arrhythmia requiring hospitalization or implantable cardioverter defibrillator over 3 years of follow-up.

    Researchers reported a stepwise increase in the primary endpoint according to the EF groups (8%, 17% and 30% for preserved, mid-range and reduced EF, respectively; p<0.001), which was derived from each individual component. Patients with mrEF had a significantly higher risk compared with those with preserved EF (hazard ratio [HR], 4.08; 95% confidence interval [CI], 2.38–6.99; p<0.001). The use of suboptimal medical therapy was associated with increased future risk, particularly in the mrEF group (HR, 2.62; 95% CI, 1.18–5.83; p=0.018). Lastly, the proportion of patients with mrEF who experienced the primary endpoint varied significantly according to kidney function and medical therapy status (8% for preserved renal function on recommended medical therapy, 20% for preserved renal function with suboptimal medical therapy, 33% for abnormal renal function on recommended medical therapy, and 50% for abnormal renal function with suboptimal medical therapy; p<0.001). 

    In conclusion, patients presenting with mrEF after STEMI had greater risk of death, heart failure hospitalization and ventricular arrhythmias than those with preserved EF. Suboptimal medical therapy in mrEF was associated with increased adverse events, especially in patients with renal dysfunction.

    Reference:
    Alkhalil M, et al. The prognostic role of mid-range ejection fraction in ST-segment elevation myocardial infarction. Int J Cardiol. 2020. doi: 10.1016/j.ijcard.2020.07.001. [Epub ahead of print]