1Universitätsklinikum Ulm Klinik für Innere Medizin II Ulm, Deutschland
Background: Several studies have investigated the course of left ventricular function (LVEF) following ST-elevation myocardial infarction (STEMI). However, analyses in patients with STEMI as first-time presentation of coronary artery disease (CAD) are scarce. Our study aimed to identify predictors of impaired LVEF in this special cohort.
Methods: Of 1381 consecutive patients with STEMI treated at our University Heart Center, 681 patients with STEMI as first-time presentation of CAD were analyzed to assess for potential bias of prior myocardial infarction or symptomatic coronary artery disease. Of these, LVEF was assessed using TOMTEC, Munich in 132 patients with eligible full-cycle echocardiography of 2- and 4-chamber view and available echocardiography at discharge and at 1-year follow-up (FU). Independent predictors of reduced LVEF <50% were assessed using multivariate logistic regression analysis.
Results: Reduced LVEF <50% was evident in 94 patients (71%) at initial laevocardiography, 91 patients (69%) at discharge and 60 patients (45%) at FU. Mean age was 63 ±12 years, 75% were male, 14% had diabetes, 73% had arterial hypertension and 56% had a history of smoking. Median DTBT was 57 [36 - 99] minutes and peak Troponin T level 2558 [1203 – 4418] ng/l. Multivariate logistic regression identified anterior wall myocardial infarction (OR 3.04 [95%-CI 1.23 – 7.49], p=0.016), peak Troponin T per 100 ng/l (OR 1.02 [95%-CI 1.01 – 1.04]; p=0.012) and door to balloon time (1.01 [95%-CI 1.00 - 1.01]) to independently predict reduced left ventricular function at 1-year FU.
Conclusion: In patients with STEMI as first-time presentation of coronary artery disease, reduced LVEF persists in almost half of the patients at 12-months follow-up. Elevated peak Troponin T levels and anterior wall myocardial infarction independently predict left ventricular dysfunction at 12-months. Furthermore, door-to-balloon time still impacts left ventricular function in times of modern revascularization strategies.
Results: Reduced LVEF <50% was evident in 94 patients (71%) at initial laevocardiography, 91 patients (69%) at discharge and 60 patients (45%) at FU. Mean age was 63 ±12 years, 75% were male, 14% had diabetes, 73% had arterial hypertension and 56% had a history of smoking. Median DTBT was 57 [36 - 99] minutes and peak Troponin T level 2558 [1203 – 4418] ng/l. Multivariate logistic regression identified anterior wall myocardial infarction (OR 3.04 [95%-CI 1.23 – 7.49], p=0.016), peak Troponin T per 100 ng/l (OR 1.02 [95%-CI 1.01 – 1.04]; p=0.012) and door to balloon time (1.01 [95%-CI 1.00 - 1.01]) to independently predict reduced left ventricular function at 1-year FU.
Conclusion: In patients with STEMI as first-time presentation of coronary artery disease, reduced LVEF persists in almost half of the patients at 12-months follow-up. Elevated peak Troponin T levels and anterior wall myocardial infarction independently predict left ventricular dysfunction at 12-months. Furthermore, door-to-balloon time still impacts left ventricular function in times of modern revascularization strategies.