SPC365

STEMI with mid-range ejection fraction - a group of intermediate risk not to be forgotten

Session: Comunicações Orais (Sessão 2) - DAC e Cuidados Intensivos 1: Síndromes Coronárias Agudas
Speaker: Joana Silva Ferreira

Congress: CPC 2022
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.6 Acute Coronary Syndromes - Clinical
Session Type: Comunicações Orais
FP Number: ---
Authors: Joana Silva Ferreira; Marta Fonseca; Sara Gonçalves; José Maria Farinha; Ana Fátima Esteves; António Pinheiro; Rui Coelho; Cátia Costa; Rui Caria

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.5pt"><span style="font-family:&quot;Segoe UI&quot;,sans-serif">Background</span></span></strong><span style="font-size:10.5pt"><span style="font-family:&quot;Segoe UI&quot;,sans-serif">: Reduced left ventricular ejection fraction (LVEF) &lt; 40% is an important negative prognostic factor&nbsp;in the setting of ST-elevation acute myocardial infarction (STEMI). On the other hand, data concerning mid-range ejection fraction (mrEF) post-STEMI are scarce and&nbsp;consequently, recommendations concerning&nbsp;reassessment of LVEF or administration of neurohormonal medication in this group of STEMI patients (pts) are still lacking.</span></span></span></span></p>

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<span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.5pt"><span style="font-family:&quot;Segoe UI&quot;,sans-serif"><strong>Purpose</strong>: To assess the current treatment and prognosis of STEMI with mrEF.</span></span></span></span></p>

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<span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.5pt"><span style="font-family:&quot;Segoe UI&quot;,sans-serif"><strong>Methods</strong>: We conducted a retrospective study including all consecutive pts hospitalized for STEMI and submitted to primary percutaneous coronary intervention in our centre in 2018. Pts were divided into 3 groups according to their LVEF assessed before hospital discharge: preserved EF (pEF: LVEF &ge; 50%), mid-range EF (mrEF: LVEF 40-49%) and reduced EF (rEF: LVEF &lt; 40%). We analysed clinical characteristics, treatment, evolution of LVEF post-STEMI and clinical outcomes - death, myocardial infarction (MI) and hospitalization for heart failure (HF) &ndash; of the mrEF group and compared it with pEF.</span></span></span></span></p>

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<span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.5pt"><span style="font-family:&quot;Segoe UI&quot;,sans-serif"><strong>Results</strong>: 188 pts with a mean age of 61 years were hospitalized for STEMI in our centre in 2018. The majority (58%, n=109) had pEF; 29% (n=55) had mrEF and 13% (n=24) were in the rEF group. Pts in the mrEF group had similar baseline characteristics to the other groups. However, compared with pEF, culprit-lesion was more often located in left main or left anterior descending arteries (80% vs 35%, p&lt;0.001) and NT-proBNP levels&nbsp;were higher&nbsp;in the mrEF pts (2270 vs 881 pg/mL, p&lt;0.001).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.5pt"><span style="font-family:&quot;Segoe UI&quot;,sans-serif">At discharge, all mrEF patients were medicated with a renin-angiotensin-aldosterone blocker and 91% with a beta-blocker.<br />
After a median of 8 months, LVEF improved a mean of 4% (&plusmn; 9%) in the mrEF group. However, in 12.5% of these pts, LVEF worsened to &lt; 40% (vs 0 in the pEF group, p=0.006).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.5pt"><span style="font-family:&quot;Segoe UI&quot;,sans-serif">At a median follow-up of 2.6 years, there was an increase in mortality according to the EF group (pEF 4% vs mrEF 13% vs rEF 48%, log-rank test: p&lt;0.001 &ndash; fig. 1) with a hazard ratio (adjusted for age) of 3.75 (95% CI 1.1-12.8, p=0.035) for mrEF vs pEF.&nbsp;</span></span></span></span></p>

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<span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.5pt"><span style="font-family:&quot;Segoe UI&quot;,sans-serif"><strong>Conclusions</strong>: This study confirms previous reports of the worse prognosis of STEMI with mrEF and suggests the existence of a continuum of risk of adverse clinical outcomes according to LVEF. Therefore, this group of intermediate risk might also benefit from neurohormonal medication, which is only specifically recommended for rEF pts in current STEMI guidelines. It also highlights the importance of a closer follow-up (with reassessment of LVEF) of mrEF pts since a non negligeable proportion ultimately progress to rEF and may require additional medical treatment or even an implantable cardioverter defibrillator. Further research with larger groups is required to identify predictors of worsening LVEF and assess the impact of neurohormonal modulation in this population.</span></span></span></span></p>