2-040 Moderate and severe left ventricular systolic impairment confer similar risks of death during long-term follow up after primary PCI for ST elevation MI

Introduction Left ventricular ejection fraction (LVEF) is one of the strongest predictors of death in patients with ischaemic heart disease. We sought to evaluate the impact of LVEF on short and long-term (10-year) mortality in patients undergoing primary PCI (PPCI) for ST elevation myocardial infarction (STEMI). Methods We identified all patients treated with PPCI for STEMI during 2014 in the Belfast Heart Attack Centre. Follow-up clinical data were obtained from the Northern Ireland Electronic Care Record, a comprehensive regional record which covers all patients in the region. We documented the baseline LVEF category from echocardiograms performed in the early recovery phase after the index STEMI. We used Kaplan-Meier time-to-event analysis to estimate the cumulative incidence of death and constructed a Cox proportional hazards regression model to calculate individual hazard ratios. Data were analysed using SPSS V.28.0. Results Six-hundred and ninety-one patients (mean age 64 +/- SD13 years; 25.4% female) who underwent PPCI during 2014 were identified, of whom 624 (90.3%) had a baseline echocardiogram. Vital status was available for all patients. Survival curves for each LVEF cohort are shown in figure 1 and statistical analyses are summarised in the table 1. Mortality rates rose progressively with declining LVEF category but after 10 years of follow-up, there was no difference between mildly reduced LVEF and normal LVEF (X²=1.5, P=0.84) nor between moderately and severely reduced LVEF (X²=0.5, P=0.48). Conclusion Over 10 years of follow-up after PPCI for STEMI, moderately impaired and severely impaired LV systolic function conferred similarly increased risks of death. While patients with moderate LV impairment are typically managed more conservatively than those with severe impairment, these data suggest that the former may merit closer follow-up, particularly in the context of expanding heart failure pharmacotherapy.