Left ventricular ejection fraction and outcomes following PCI in STEMI and other acute coronary syndromes: ACC NCDR registry in India.

OBJECTIVE

To assess influence of echocardiographic left ventricular ejection fraction(LVEF) on outcomes following percutaneous coronary intervention(PCI) in ST-elevation myocardial infarction(STEMI) and other acute coronary syndromes(oACS).

METHODS

Successive patients with ACS who underwent PCI from April'2019 to March'2022 were enrolled, while those who did not undergo PCI were excluded. In all patients, LVEF was obtained at hospital admission and classified into <30.0%,30.0-39.9%,40.0-49.9% and ≥50.0%. Details of risk factors, coronary angiography, interventions, management, and in-hospital and 3-year outcomes were obtained. Multivariate Cox-proportionate hazard ratios(HR) and 95% confidence intervals(CI), adjusted for age, sex, risk factors, presentation, angiography, interventions, management, and hospitalisation, for major adverse cardiovascular events(MACE) and deaths were calculated.

RESULTS

Data of 3789 patients (men 3011, women 778) with ACS (STEMI = 1601; oACS = 2188) were available at baseline and 3.0yr (IQR 2.1-4.0) median follow-up. STEMI patients were younger, with more men, smoking, hypercholesterolemia, impaired LVEF, vasopressor support, hospitalisation duration, and in-hospital deaths vs oACS (p < 0.01). Important determinants of reduced LVEF were smoking, 3-vessel, left-main or left anterior descending CAD (p < 0.01). In both groups, patients with lower LVEF(<30.0%,30.0-39.9%) had more in-hospital deaths (p < 0.05). At 3-year follow-up, compared to LVEF >50.0%, multivariate-adjusted HR(95%CI) in LVEF<30.0% for MACE [STEMI 8.55(3.04-24.03); oACS 2.71(1.39-5.29)] as well as CV deaths [STEMI 16.50(3.64-74.71); oACS 3.72(1.40-9.85)] were significant (p < 0.001). For LVEF 30.0-39.9% group, HRs were of borderline significance [STEMI 2.26(0.86-5.89);oACS 1.34(0.76-2.36)] and not significant for LVEF 40.0-49.9% group. Outcomes were not significantly different in men and women.

CONCLUSIONS

STEMI and other ACS patients undergoing PCI with LVEF<30% have significantly higher in-hospital and 3-year major adverse cardiovascular events and deaths.