Left Ventricular Ejection Fraction Trajectory and Long-Term Outcomes Following Percutaneous Coronary Intervention for Myocardial Infarction

BACKGROUND: Data are lacking on left ventricular ejection fraction (LVEF) trajectory following myocardial infarction (MI). OBJECTIVES: This study aimed to evaluate the impact of LVEF trajectory after percutaneous coronary intervention (PCI) for MI on long-term outcomes. METHODS: Patients undergoing PCI for MI (2007-2022) with serial echocardiograms were identified in the Swedish Coronary Angiography and Angioplasty Registry and the UC San Diego internal National Cardiovascular Data Registry CathPCI Registry. All-cause mortality and heart failure hospitalization within 6 years were assessed with time-to-event analysis adjusted for baseline characteristics. RESULTS: Of 13,439 patients (mean age 64 ± 10 years, 24.5% female, 46.8% ST-segment elevation MI), 28.2% had consistently reduced LVEF (redEF), 14.8% recovered their LVEF (recEF), 53.0% had consistently preserved LVEF (pEF), and 3.9% decreased from preserved to reduced LVEF (decEF). Heart failure hospitalization rates were 40.0% for redEF, 30.4% for decEF, 16.1% for recEF, and 6.4% for pEF (P < 0.001). Compared to pEF, the heart failure hospitalization risk was significantly higher for redEF (adjusted HR [aHR]: 8.49; 95% CI: 7.49-9.64; P < 0.001), decEF (aHR: 5.74; 95% CI: 4.69-7.02; P < 0.001), and recEF (aHR: 3.18; 95% CI: 2.70-3.76; P < 0.001). Mortality rates were 14.0% for redEF, 14.9% for decEF, 7.8% for recEF, and 6.7% for pEF (P < 0.001). Compared to pEF, the mortality risk was significantly higher for redEF (aHR: 2.20; 95% CI: 1.86-2.59; P < 0.001), decEF (aHR: 2.10; 95% CI: 1.56-2.82; P < 0.001), and recEF (aHR: 1.30; 95% CI: 1.02-1.65; P = 0.032). CONCLUSIONS: LVEF trajectory after MI significantly impacts long-term outcomes. Even patients with LVEF recovery remain at increased risk for heart failure hospitalization and mortality compared to those with pEF.