| Objective: The objective of this study was to investigate patients with acute ST-segment elevation myocardial infarction(STEMI)with stents implanted,measure the left ventricular ejection fraction(LVEF)before and 12 months after reperfusion therapy in patients with STEMI by echocardiography,study the magnitude and direction of changes(improvement or deterioration)in left ventricular function,compare the data of patients with long-term LVEF compared with the baseline LVEF recovery group and the non-recovery group,and explore the impact of LVEF recovery or non-recovery on their prognosis.and explore the independent influencing factors of LVEF recovery,and put forward new insights and ideas for formulating treatment plans to improve cardiac function and prevent cardiac function deterioration in patients with acute STEMI.Methods: Patients with acute STEMI treated with PCI within 12 hours of onset and underwent echocardiography within 48 hours after the procedure from January 1,2020,to December 31,2021,at North Jiangsu People’s Hospital,and those who had a repeat echocardiography at 11-13 months after the procedure were included in this study.LVEF data were collected from all enrolled patients at 48 hours after PCI and at 11-13 months after PCI,and the patients were divided into recovery and non-recovery groups based on whether LVEF remained or increased or decreased from baseline to 11-13 months of follow-up.Baseline data including general information,past medical history,hospital admission,test parameters,coronary angiography records and out-of-hospital medications were collected.The clinical characteristics were compared.The prognosis of patients with acute STEMI was followed up by telephone and outpatient records until December 31,2022.Cumulative event rates of clinical outcomes were compared between the two groups using Kaplan-Meier curves and Log-rank tests,and Cox proportional risk models were used to assess the impact of LVEF recovery.Binary logistic regression models were used to the independent influences of LVEF recovery.Results: The study ultimately included 170 acute STEMI patients with a mean age of(62.1±13.3)years and 82.4% men in the analysis,including 98(57.6%)in the recovery group and 72(42.4%)in the non-recovery group.In terms of analysis of the data collected so far,comparison of the results of the baseline data of the two groups showed that compared with the recovered group,patients in the unrecovered group had a higher number of days of hospitalization(P < 0.01),peak NT-proBNP(P < 0.01),peak cTnI(P < 0.001),peak CKMB(P < 0.01),proportion of patients with echocardiography suggestive of mitral regurgitation(P < 0.05),TIMI classification of left anterior descending flow(P < 0.01),total stent length(P < 0.05),proportion of left anterior descending branches of the offender vessel(P < 0.05),and Gensini score(P < 0.05)were higher.LVEF improved significantly(P < 0.001)from baseline in the recovered group and decreased significantly(P < 0.001)from baseline in the unrecovered group at 11-13 months after surgery.With a median follow-up of 20 months,Long-term clinical outcomes showed that all-cause mortality(P<0.05)and rehospitalization rate due to heart failure(P<0.01)were significantly higher in the non-recovery group than in the recovery group.The cumulative event rate of the composite endpoint was significantly higher in the non-recovery group than in the recovery group(P=0.001).Cox regression analysis showed that LVEF recovery was an independent predictor of the composite endpoint after adjusting for days in hospital,peak NT-proBNP,peak cTnI,peak CKMB,mitral regurgitation,left anterior descending branch flow TIMI grade,total stent length,offender vascular,and Gensini score.Binary logistic regression of LVEF recovery showed CKMB peak(OR 2.995,95% CI 1.991-6.195,P=0.014),mitral regurgitation(OR 1.925,95% CI 1.302-3.723,P=0.021),total stent length(OR 1.981,95% CI 1.359-3.298,P=0.032),Gensini score(OR 2.080,95% CI 1.069-4.407,P=0.011)was an independent influencing factor on LVEF recovery in patients with acute STEMI.Conclusions: 1.Patients with acute STEMI who underwent emergency PCI 12 months after LVEF recovery NT-proBNP peak,cTnI peak,CKMB peak,proportion of patients with mitral regurgitation on echocardiography,TIMI grade of left anterior descending blood flow,total length of stent placement,proportion of left anterior descending branch of offender blood vessels and lower Gensini score,indicating that the range of myocardial infarction had a certain degree of influence on the long-term LVEF improvement of patients.2.LVEF recovery 12 months after surgery in patients with acute STEMI can significantly reduce the risk of all-cause mortality.Peak CKMB,mitral regurgitation,total stent length,and Gensini score were independent risk factors for LVEF recovery. |
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