Recovery of Left Ventricular Function Three Months after Primary PCI in STEMI Patients: A Prospective Observational Study of 830 Patients

OBJECTIVE: To evaluate recovery of LVEF at 3 months after primary PCI and identify predictors of improvement. METHODOLOGY: We conducted a prospective observational study of 830 consecutive STEMI patients undergoing primary PCI at SICVD Satellite centres of Larkana, Sukkur, Hyderabad and Sehwan between May and August 2025. Transthoracic echocardiography was performed within 24 hours of admission and repeated at 3 months. LVEF was measured by Simpson’s biplane method. RESULTS: Mean age was 58±11 years, 74% were male, 36% had diabetes, and 42% had hypertension. Baseline LVEF was 42.1% ± 9.8%. At 3 months, mean LVEF improved to 47.9% ± 10.4% (mean change +5.8%, p<0.001). 68% of patients showed ≥5% absolute EF recovery, while 41% improved ≥10%. Predictors of greater recovery included anterior MI (β=+2.3%, p=0.02), baseline EF <40% (β=+3.5%, p<0.001), successful final TIMI 3 flow (β=+4.1%, p<0.001), and use of guideline-directed medical therapy (ACEi/ARB/ARNI and beta-blockers, both p<0.05). CONCLUSION: In a large real-world STEMI cohort, LVEF significantly improved by 3 months after primary PCI, particularly in patients with lower baseline EF, successful reperfusion, and optimal medical therapy.