Key result
Female sex predicts ~112% greater odds of LVEF improvement after STEMI, while higher EF predicts deterioration.
Why the study?
Changes in LVEF after STEMI are associated with subsequent ischemic events and mortality, but the determinants of mid-term improvement and deterioration were not fully established.
Observational (n=585)
In patients with STEMI, higher baseline EF, lower hemoglobin, and higher peak creatine kinase predict mid-term LVEF deterioration, whereas female sex and LM-LAD infarct-related artery predict LVEF improvement.
Female sex was associated with post-STEMI LVEF improvement and higher baseline EF with deterioration; hypothesis-generating and requires prospective validation.
Objective Changes in the left ventricular ejection fraction (LVEF) after an ST-segment elevation myocardial infarction (STEMI) are associated with subsequent ischemic events and mortality. This study aimed to investigate the determinants of a mid-term improvement and deterioration of LVEF in patients with STEMI. Methods We included 585 patients with STEMI who had a modified Simpson EF both at index admission and mid-term (6-12 months) follow-up. We divided the patients into the EF deterioration group (≥10% decrease in EF, n=38), the EF improvement group (≥10% increase in EF, n=127), and the unchanged EF group (<10% change in EF, n=420). Results Baseline EF was significantly associated with an EF deterioration (OR1.472 per 5.0 % increase, 95%CI:1.231-1.761, p<0.001). The hemoglobin levels were inversely associated with an EF deterioration (OR0.760 per 1.0 g/dL increase, 95%CI: 0.632-0.914, p=0.003). The peak creatine kinase levels were significantly associated with an EF deterioration (OR1.034 per 100 U/L increase, 95%CI: 1.019-1.050, p<0.001). A female sex was significantly associated with an EF improvement (OR2.118, 95%CI: 1.222-3.671, p=0.008). The pulse rate was inversely associated with an EF improvement (OR0.887 per 10 bpm increase, 95%CI: 0.791-0.995, p=0.041). Infarct-related artery with LMT-left anterior descending artery was significantly associated with an EF improvement (OR1.661, 95%CI: 1.009-2.734, p=0.046). Time interval between the Baseline EF and follow-up EF was significantly associated with an EF improvement (OR1.008, 95%CI: 1.002-1.013, p=0.006). The peak creatine kinase level (OR0.981 per 100 U/L increase, 95%CI: 0.970-0.992, p<0.001) and baseline EF (OR0.568, 95%CI: 0.500-0.645, p<0.001) was inversely associated with an EF improvement. Conclusion A higher baseline EF, lower hemoglobin levels at admission, and higher peak creatine kinase levels were associated with a mid-term deterioration of LVEF, whereas a female sex, LM-LAD as the infarct-related artery, and the time interval between baseline and follow-up EF were associated with a mid-term improvement in LVEF. Knowledge of these determinants may help to refine the post-STEMI risk stratification and therapeutic strategies.
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Nanri et al. (2026) conducted an observational in ST-segment elevation myocardial infarction (n=585). Female sex (OR 2.118; 95% CI 1.222-3.671) predicted mid-term LVEF improvement, while higher baseline EF (OR 1.472; 95% CI 1.231-1.761) and peak CK predicted LVEF deterioration in STEMI patients.
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