Clinical correlates of early post-PCI left ventricular ejection fraction in patients with STEMI: a single-center retrospective study

INTRODUCTION: Early left ventricular systolic dysfunction after primary percutaneous coronary intervention (PCI) remains common in ST-segment elevation myocardial infarction (STEMI) and is associated with adverse remodeling and heart failure. The clinical relevance of lipid markers and lipid ratios for characterizing early post-PCI ventricular dysfunction beyond angiographic and hemodynamic features remains uncertain. METHODS: We conducted a single-center retrospective study of consecutive patients with STEMI undergoing emergency PCI at Nanjing BenQ Hospital (2014-2023). LVEF was assessed by transthoracic echocardiography 24-72 h post-PCI, and reduced LVEF was defined as < 50%. Lipids were measured from the first blood sample obtained on admission, and LDL-C/HDL-C and TG/HDL-C were calculated. Multivariable linear and logistic regression models with hierarchical adjustment (Model 2 additionally including log1p-transformed troponin I measured from the first blood sample obtained on admission) were used to identify factors associated with LVEF and reduced LVEF. Discrimination of lipid markers was evaluated using ROC analysis. RESULTS: Among 254 patients, 45 (17.7%) had reduced LVEF. LAD as the infarct-related artery (IRA) was more frequent in the reduced-LVEF group (73.3% vs. 48.3%, P = 0.002). LAD-IRA was independently associated with lower LVEF (β = -5.240; P < 0.001) and higher odds of reduced LVEF (OR = 4.005; P < 0.001). Higher systolic blood pressure was associated with lower odds of reduced LVEF (P = 0.026). TG/HDL-C showed modest discrimination (AUC = 0.605), whereas LDL-C showed no meaningful discrimination (AUC = 0.492). CONCLUSION: In PCI-treated STEMI, LAD culprit territory and admission systolic blood pressure were the main clinical correlates of early post-PCI LV dysfunction, whereas TG/HDL-C showed only modest discrimination and limited standalone clinical utility. These findings should be considered exploratory and hypothesis-generating.