Predictors of depressed left-ventricular ejection fraction after acute myocardial infarction

Abstract Introduction Impairment of left-ventricular ejection fraction (LVEF) is a major determinant of poor outcome after myocardial infarction (MI). Data on predisposing factors from larger cohorts including both patients with ST-elevation MI (STEMI) and non-STEMI are however, scarce. Methods Registry-based cohort study (SWEDEHEART) investigating 48,621 patients with STEMI and 73,708 patients with non-STEMI, admitted to Swedish hospitals between 2010 and 2022. Patients with known heart failure, cardiac arrest or cardiopulmonary resuscitation prior to admission were excluded. Depressed LVEF was defined as 0.40, estimated in-hospital. Multivariable logistic regressions were used to study the associations of risk factors, comorbidities, baseline medications (betablockers, renin-angiotensin-aldosterone-inhibitors, statins) and angiographic features with depressed LVEF. Results LVEF 0.40 was noted in 23,165 (47.6%) STEMI patients and in 20,978 (28.5%) non-STEMI patients. In models adjusted for admission year, hospital, demographics and coronary revascularization, anterior MI localization was the strongest predictor of LVEF 0.40 in STEMI (OR 4.32 95% CI 4.07-4.59) while three-vessel disease/left main stenosis was one of the strongest predictors in non-STEMI (OR 1.78 95% CI 1.67-1.90). Baseline medications conferred no protective effects. Smoking, diabetes, underweight (BMI 18.5 kg/m2), lower estimated glomerular filtration rate (eGFR) and estimates of preexisting atherosclerotic disease (previous MI, previous stroke, peripheral artery disease) independently predicted LVEF 0.40 in both MI types after additional adjustment for angiographic data, see Table. Hypertension and overweight (BMI 25-29.9 kg/m2) were inversely associated with LVEF 0.40. Interaction analyses revealed stronger associations of smoking, chronic obstructive pulmonary disease (COPD), peripheral artery disease and lower eGFR with depressed LVEF in non-STEMI (p 0.01). Conclusions Anterior MI localization and the extent of coronary disease are major determinants of depressed LVEF after MI, underscoring the importance of complete revascularization during hospitalization. Several other risk factors and comorbidities were associated with LVEF 0.40 with stronger relative importance observed in non-STEMI for conditions potentially portending to more widespread coronary disease. The inverse associations of hypertension and overweight warrant further investigation to inform customized preventive strategies.