| Objective: This study sought to evaluate the impact of left ventricular ejection fraction(LVEF)recovery in patients with mid-range ejection fraction(mrEF)after ST-segment elevation myocardial infarction(STEMI),and further explored the independent factors of LVEF recovery.Methods:Patients whose LVEF was between 40% and 49% after primary percutaneous coronary intervention(PCI)in acute STEMI were consecutively enrolled from January 2017 to December 2019 in Hebei General Hospital.LVEF was measured by echocardiography within 3 days and 3 months after PCI.Patients were divided into the recovery group and no-recovery group according to whether LVEF recovered to 50% from baseline to 3 months after PCI.The clinical data of patients was collected including general information,medical history,admission status,laboratory biomarkers,PCI related information and discharged medications through the electronic medical record system.The clinical characteristics and changes of LVEF between the recovery group and the no-recovery group were compared.Long-term outcomes of STEMI patients with mrEF containing all-cause death,myocardial infarction,revascularization,hospitalization for heart failure,and stroke were followed up until December 31,2020.Kaplan-Meier curve and Log-rank test were used to compare the cumulative event rates of the clinical outcomes between the two groups,and Cox proportional risk model was applied to evaluate the impact of LVEF recovery on the long-term prognosis of STEMI patients with mrEF.Meanwhile,the logistic regression model was used to analyze the independent predictors of LVEF recovery.Results: A total of 107 STEMI patients with mrEF were enrolled in this study,including 79 patients(73.8%)in the recovery group and 28 patients(26.2%)in the no-recovery group.The mean age was 60.1±12.3 years and 83.2% was male.The results showed that patients in the no-recovery group had higher percentage of Killip Ⅱ-grade,Ⅳhigher peak creatine kinase-myocardial band(CK-MB),higher peak N-terminal pro-brain natriuretic peptide(NT-proBNP),higher white blood cell count,lower estimated glomerular filtration rate,lower baseline LVEF,and longer total ischemia time compared with those in the recovery group(P<0.05).LVEF in the recovery group was improved from baseline to 3months after PCI(P<0.05),while there was no significant change in the no-recovery group.Long-term outcomes of STEMI patients with mrEF were followed up with a median time of 29 months.The mortality and the rate of hospitalization for heart failure were significantly higher in the no-recovery group than those in the recovery group(P<0.05),whereas no significant difference was observed in myocardial infarction,revascularization and stroke between the two groups(P>0.05).The cumulative event rate of the composite endpoint of all-cause death,myocardial infarction,revascularization,hospitalization for heart failure,and stroke in the no-recovery group was significantly higher than that in the recovery group(P=0.002).In a multivariate Cox regression model,LVEF recovery was independently associated with the composite endpoint(HR 2.55,95%CI 1.03-6.29,P=0.043)after adjusted by age,peak NT-proBNP,estimated glomerular filtration rate and the average diameter of the stent.Multivariate logistic regression found that peak CK-MB(OR 0.996,95%CI 0.992-0.999,P=0.008),peak NT-proBNP(OR 0.999,95%CI 0.999-1.000,P<0.001),baseline LVEF(OR1.293,95%CI 1.029-1.626,P =0.028),and total ischemic time(OR 0.996,95%CI 0.993-0.999,P=0.023)were independent factors of LVEF recovery in STEMI patients with mrEF.Conclusions: LVEF recovery was independently associated with the reduced risk of composite endpoint event of all-cause death,myocardial infarction,revascularization,hospitalization for heart failure and stroke in STEMI patients with mrEF.Peak CK-MB,peak NT-proBNP and total ischemic time were independent risk factors,and baseline LVEF was an independent protective factor of LVEF recovery. |
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