Prevalence and prognostic implications of reduced left ventricular ejection fraction among patients with STEMI in India

Abstract

AimsTo describe clinical characteristics and outcomes for those with STEMI and reduced left ventricular ejection fraction (LVEF) in low-income and middle-income countries (LMICs). Methods and resultsAdults presenting with STEMI to two government-owned tertiary care centres in Delhi, India were prospectively enrolled in the North India ST-elevation myocardial infarction (NORIN-STEMI) registry. LVEF was evaluated at presentation and clinical characteristics were compared across LVEF categories. Overall, 3597 patients were included, of whom 468 (13%) had LVEF >50%, 1482 (41%) had mildly reduced LVEF (40-49%), 1357 (38%) had moderately reduced LVEF (30-39%), and 290 (8%) had severely reduced LVEF (<30%). Presentation delay >24 h, prior MI, and hyperlipidaemia were associated with decreasing LVEF category. Although most patients with reduced LVEF were discharged on appropriate guideline-directed therapies, adherence at 1 year was low (ACE inhibitor/ARB 91% to 41%, beta blocker 98% to 78%, aldosterone receptor antagonist 69% to 6%). After multivariable adjustment, a Cox regression model showed moderately reduced LVEF (HR 1.77, 95% CI 1.20, 2.60) and severely reduced LVEF (HR 3.63, 95% CI 2.41, 5.48) were associated with increased risk of all-cause mortality compared with LVEF ≥50%. Conclusions On presentation for STEMI, almost 90% of NORIN-STEMI participants had at least mildly reduced LVEF and almost half had LVEF <40%. Patients with LVEF <40% had significantly higher risk of mortality at 1 year, and adherence to guideline-directed therapies at 1 year was poor. Systematic initiatives to improve access to timely revascularization and guideline-directed therapies are essential in advancing STEMI care in LMICs.

Fibrinogen and Intracoronary Thrombus as Predictors of Major Adverse Cardiovascular Events In-Hospital in St-Elevation Myocardial Infarction (STEMI) Patients Undergoing Primary Percutaneous Coronary Intervention

“…This is in accordance with research conducted by Fraticelli et al with BMI  25[16]. Risk factors such as smoking, hypertension, DM and dyslipidemia were also identified as causes of STEMI in line with previous findings by Hendrickson 2022 and Fraticelli 2020[15,16].…”

“…. Other research conducted by Hendrickson et al also obtained the age of STEMI patients 55 years[15]. In gender, the majority of STEMI patients are male.…”

Comparative evaluation of machine learning models versus TIMI score in ST-segment-elevation myocardial infarction patients

“…Whilst on the other hand, LVEF > 40%, use of aspirin, beta blockers, ACEi/ARBs significantly favored survival in this cohort of patient. Lower LVEF is already an established risk factor for higher mortality as reported by sub analysis of NORIN-STEMI registry 27 . Cardiogenic shock, reported in up to 10% of STEMI patients, carries high mortality rates of around 40% at 30 days and 50% at one year 28 .…”

Influencing factors and prognostic value of left ventricular systolic dysfunction in patients with complete occlusion of the left anterior descending artery reperfused by primary percutaneous coronary intervention

“…Timely identification of subjects at risk for HF development using a multimodality approach and early initiation of guideline-directed HF therapy in these patients can decrease the HF burden [ 13 ]. Previous studies had confirmed that age, delayed presentation, previous history of myocardial infarction, atrial fibrillation, hyperlipidaemia, renal impairment, anterior localization of AMI and proximal lesion location were the risk factors of LVSD in STEMI patients [ 14 – 18 ]. And some markers, such as peak CK, B-type natriuretic peptide, fasting blood glucose, stress marker total thiol groups, and fibrosis marker HE-4 had been confirmed to be associated with rLVEF after STEMI [ 19 – 21 ].…”