Document Type : Original Article
Department of Cardiology and Cath lab, Public Health Centre, West Mambalam, Chennai, India.
Meditrina Hospitals, Kollam, Kerala, India.
MBH Hospitals, Malappuram, Kerala, India.
Apollo Hospital, Greams Road, Chennai, India.
Background: Well-timed primary percutaneous coronary intervention (PCI) is known to improve survival, limit infarct size, and improve left ventricular ejection fraction (LVEF) in patients with ST-elevation myocardial infarction (STEMI). Nonetheless, many patients do not recover their LV contractile function after primary PCI and eventually progress to heart failure. This study aimed to assess the predictors of improvement in LVEF after successful primary PCI among patients presenting with STEMI within 12 hours of symptom onset.
Methods: Our single-center, prospective, observational study enrolled 246 consecutive STEMI patients presenting within 12 hours of symptom onset. All the patients underwent echocardiography at presentation and at a 3-month follow-up. Multivariate analysis was used to identify the predictors of improvement in LVEF in the course of the convalescent phase.
Results: Data of 239 patients were analyzed for the study. The mean age of the patients was 54.2±11.3 years, and 90% of the patients were male. Diabetes and hypertension were prevalent at 44.8% and 38.9%. The average total ischemic and door-to-balloon time was 260 (175–440) and 60 (40–65) minutes, respectively. LVEF showed improvement in more than half of the patients (57.7%) at 3 months’ follow-up. The binomial regression analysis of various variables, predicting LVEF improvement at 3 months, showed that the most significant predictor of LVEF improvement was a shorter total ischemic time (P<0.001; OR, 1.01; 95% CI, 1.00 to 1.01), followed by LVEF of 40% or higher at presentation (P<0.02; OR,1.01; 95% CI, 0.95 to 1.01).
Conclusions: In patients with STEMI, the total ischemic time and LV systolic function at presentation can help predict EF recovery after successful primary PCI. Patients at risk can be treated with aggressive medical management. (Iranian Heart Journal 2022; 23(4): 69-79)