Long-Term Risk of Cardiovascular Death in Patients With Mildly Reduced Ejection Fraction After Acute Myocardial Infarction: A Multicenter, Prospective Registry Study

• Published in: Journal of the American Heart Association 2024-09, Vol.13 (18), p.e034870
• Main Authors: Kim, Hwajung, Lee, Kwan Yong, Choo, Eun Ho, Hwang, Byeong-Hee, Kim, Jin Jin, Kim, Chan Joon, Chang, Kiyuk, Hong, Young Joon, Kim, Ju Han, Ahn, Youngkeun, Choi, Young
• Format: Article
• Language: English
• Subjects: acute myocardial infarction; Aged; cardiovascular death; Cause of Death; Female; heart failure; Humans; Incidence; Japan - epidemiology; left ventricular ejection fraction; Male; Middle Aged; mildly reduced ejection fraction; Myocardial Infarction - mortality; Myocardial Infarction - physiopathology; Prognosis; Prospective Studies; Registries; Risk Assessment - methods; Risk Factors; Stroke Volume - physiology; Time Factors; Ventricular Dysfunction, Left - epidemiology; Ventricular Dysfunction, Left - mortality; Ventricular Dysfunction, Left - physiopathology; Ventricular Function, Left
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.124.034870

The prognostic implication of mildly reduced ejection fraction (mrEF) after acute myocardial infarction has not been clearly demonstrated. We investigated the long-term risk of cardiovascular death and its predictors in patients with mrEF following acute myocardial infarction. A total of 18 668 patients who presented with acute myocardial infarction were included in 2 prospective, multicenter registries. The incidence of adverse cardiovascular events according to the left ventricular ejection fraction (EF) strata at index admission were evaluated. A score system consisting of clinical variables were developed to predict long-term cardiovascular death in the mrEF group. There were 2548 patients with reduced EF (EF ≤40%), 4266 patients with mrEF (EF 41%-49%), and 11 854 patients with preserved EF (EF ≥50%). During a median follow-up period of 37.9 months, the cardiovascular death rate was 22.3% in the reduced EF group, 10.3% in the mrEF group, and 7.3% in the preserved EF group ( 65 years, hypertension, stroke, severe renal insufficiency, and Killip class ≥3 were independent predictors for cardiovascular death. Presence of >2 predictors best discriminated the high-risk patients for cardiovascular death with an area under the curve of 0.746. Incidence of cardiovascular death in the high-risk mrEF group was comparable with the rEF group, while it was lower in the low-risk mrEF group than in the pEF group. Patients with mrEF after acute myocardial infarction had a modest risk of cardiovascular death. Clinical predictors could help discriminate a high-risk subpopulation with cardiovascular death risks comparable with those in the reduced EF group.