Global myocardial work efficiency provides incremental prognostic value in STEMI patients undergoing PCI

Abstract Objective Echocardiographic parameters such as left ventricular ejection fraction (LVEF) and global longitudinal strain are commonly used for risk stratification in patients with acute ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). However, their prognostic accuracy is influenced by loading conditions. We aimed to evaluate whether myocardial work (MW), accounting for afterload, offers prognostic value beyond conventional echocardiographic parameters. Methods We prospectively enrolled 215 STEMI patients (mean age 61±10 years) who underwent PCI within 12 hours of symptom onset and early echocardiography. Patients were followed for major adverse events (MAE), defined as all-cause mortality, unplanned cardiovascular hospitalization, ventricular arrhythmias, or stroke. Results During a median follow-up of 7 months (interquartile range 5-15), 40 patients experienced MAE. Among echocardiographic parameters, global work efficiency (GWE) was the only variable significantly different between patients with and without events. In univariable analysis, hypertension, peak value of creatine-kinase isoform-MB, and MW parameters (global work index, global constructive work, and GWE) were significantly associated with outcomes. In multivariable Cox regression, each 5% decrease in GWE was associated with a 16.5% increased risk of MAE (HR = 0.835, 95%CI = 0.693 – 0.985, p = 0.03). Sequential Cox models showed that adding LVEF to a baseline clinical model (age, Killip class, glomerular filtration rate) provided minimal improvement, whereas inclusion of GWE significantly enhanced model performance (likelihood ratio X 2 =4.90, p =0.02). Conclusion In STEMI patients undergoing PCI, GWE independently predicts MAE and provides incremental prognostic information beyond clinical and echocardiographic parameters. Incorporating GWE into risk assessment may improve identification of high-risk patients for targeted post-infarction management.