What is the clinical evidence from this study?

Study design: Observational. Population: ST-elevation myocardial infarction undergoing percutaneous coronary intervention (n=215). Intervention: Myocardial work parameters, specifically global work efficiency (GWE) vs. Conventional echocardiographic parameters including left ventricular ejection fraction (LVEF). Primary outcome: Major adverse events (MAE) defined as all-cause mortality, unplanned cardiovascular hospitalization, ventricular arrhythmias, or stroke (HR 0.835 per 5% increase in GWE, 95% CI 0.693–0.985, p=0.033).

What does this research mean for the field?

Global work efficiency (GWE) independently predicts major adverse events (MAE) in STEMI patients undergoing PCI and provides incremental prognostic information beyond conventional echocardiographic parameters. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

February 26, 2026Open Access

Global myocardial work efficiency provides incremental prognostic value in STEMI patients undergoing PCI

Key Result

Global work efficiency independently predicted major adverse events with a hazard ratio of 0.835 per 5% increase, providing incremental prognostic value beyond clinical and echocardiographic parameters in STEMI patients after PCI.

Key Points

To assess whether myocardial work provides prognostic value beyond conventional echocardiographic parameters in STEMI patients undergoing PCI.
Prospective enrollment of 215 STEMI patients undergoing PCI.
Early echocardiography was performed within 12 hours of symptom onset.
Follow-up tracked major adverse events (MAE) including mortality and hospitalization.
40 patients experienced major adverse events during a median follow-up of 7 months.
Global work efficiency was significantly different between patients with and without events.
A 5% decrease in global work efficiency increased the risk of MAE by 16.5%.
Inclusion of global work efficiency improved prognostic model performance significantly.

Study Design

Type

Observational (n=215)

Multicenter

Structured PICO

Does global work efficiency (GWE) provide incremental prognostic value for predicting major adverse events in STEMI patients undergoing primary PCI?

Population

215 patients with acute ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) within 12 hours of symptom onset, mean age 61±10 years, 78.1% male. Exclusions: significant valvular disease, fixed or dynamic left ventricular outflow tract obstruction, atrial fibrillation or marked R-R variability, permanent pacemaker, life expectancy < 1 year due to comorbidities, or poor echocardiographic quality.

Intervention

Echocardiographic assessment of global work efficiency (GWE) and other myocardial work parameters performed within 4 days of admission.

Outcome

Major adverse events (MAE), defined as a composite of unplanned cardiovascular hospitalization (for heart failure or acute coronary syndrome), malignant ventricular arrhythmias, stroke, and/or all-cause mortality at a median follow-up of 7 months.composite

Global work efficiency (GWE) provides independent and incremental prognostic value beyond LVEF and clinical factors for predicting major adverse events in STEMI patients following primary PCI.

Main Result

Effect estimate: HR 0.835 per 5% increase in GWE (95% CI 0.693–0.985)

p-value: p=0.033

Limitations

Single-center study limiting generalizability
Moderate sample size and relatively short follow-up limiting detection of hard endpoints such as mortality
Study excluded patients with severe valvular disease, LV outflow tract obstruction, atrial fibrillation, marked R-R variability, or permanent pacemakers, limiting applicability to these populations
No serial myocardial work assessments performed to evaluate temporal changes
Speckle-tracking analysis is operator-dependent despite standardized protocols

Abstract

Abstract Objective Echocardiographic parameters such as left ventricular ejection fraction (LVEF) and global longitudinal strain are commonly used for risk stratification in patients with acute ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). However, their prognostic accuracy is influenced by loading conditions. We aimed to evaluate whether myocardial work (MW), accounting for afterload, offers prognostic value beyond conventional echocardiographic parameters. Methods We prospectively enrolled 215 STEMI patients (mean age 61±10 years) who underwent PCI within 12 hours of symptom onset and early echocardiography. Patients were followed for major adverse events (MAE), defined as all-cause mortality, unplanned cardiovascular hospitalization, ventricular arrhythmias, or stroke. Results During a median follow-up of 7 months (interquartile range 5-15), 40 patients experienced MAE. Among echocardiographic parameters, global work efficiency (GWE) was the only variable significantly different between patients with and without events. In univariable analysis, hypertension, peak value of creatine-kinase isoform-MB, and MW parameters (global work index, global constructive work, and GWE) were significantly associated with outcomes. In multivariable Cox regression, each 5% decrease in GWE was associated with a 16.5% increased risk of MAE (HR = 0.835, 95%CI = 0.693 – 0.985, p = 0.03). Sequential Cox models showed that adding LVEF to a baseline clinical model (age, Killip class, glomerular filtration rate) provided minimal improvement, whereas inclusion of GWE significantly enhanced model performance (likelihood ratio X 2 =4.90, p =0.02). Conclusion In STEMI patients undergoing PCI, GWE independently predicts MAE and provides incremental prognostic information beyond clinical and echocardiographic parameters. Incorporating GWE into risk assessment may improve identification of high-risk patients for targeted post-infarction management.

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