Heart Failure After ST-Elevation Myocardial Infarction: Beyond Left Ventricular Adverse Remodeling

ST-segment elevation myocardial infarction (STEMI) remains a significant source of morbidity and mortality worldwide. Despite advances in treat-ment leading to a significant reduction in the early complications and in-hospital mortality, a significant proportion of STEMI survivors develop heart failure (HF) at follow-up. The classic paradigm of HF after STEMI is one characterized by left ventricular adverse remodeling (LVAR) and encompasses the pro-cess of regional and global structural and functional changes that occur in the heart as a consequence of loss of viable myocardium, increased wall stress and neurohormonal activation, and results in HF with reduced ejection fraction (HFrEF). More recently, however, with further improvements in the treatment of STEMI the incidence and entity of LVAR appear to be largely reduced, yet the risk for HF following STEMI is not abolished and remains substantial, iden-tifying a new paradigm by which patients with STEMI present with HF and preserved EF (HFpEF) charac-terized by reduction of diastolic or systolic reserve independent of LVAR.

Automated summary

ST-segment elevation myocardial infarction (STEMI) is a significant cause of morbidity and mortality worldwide. Although treatment advancements have reduced early complications and in-hospital mortality, a considerable number of STEMI survivors develop heart failure (HF) in the long-term. Traditionally, HF after STEMI is characterized by left ventricular adverse remodeling (LVAR), but recent improvements in STEMI treatment have reduced the incidence and form of LVAR while the risk of HF remains substantial, leading to a new paradigm of HF with preserved ejection fraction (HFpEF) independent of LVAR.