Journal
JOURNAL OF CLINICAL MEDICINE
Volume 11, Issue 21, Pages -Publisher
MDPI
DOI: 10.3390/jcm11216252
Keywords
left ventricular remodeling; ST-segment elevation myocardial infarction; multivessel disease; complete revascularization; heart failure
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Funding
- Chonnam National University Hospital Biomedical Research Institute [CRI18003-1]
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In this study, the impact of left ventricular remodeling (LVR) on the prognosis of patients with ST-elevated myocardial infarction and multivessel disease was examined. LVR was associated with worse outcomes only in patients who received incomplete revascularization. The study highlights the importance of considering LVR in the management of these patients.
In this study, we identified several factors related to left ventricular remodeling (LVR) and examined the impact of LVR on the prognosis of patients with ST-elevated myocardial infarction and multivessel disease treated with complete (CR) or incomplete (IR) revascularization. LVR was defined as an LV end-diastolic diameter >55 mm. A total of 262 patients without LVR at presentation were followed up with echocardiography between 1 month and 1 year. The primary outcome was a composite of all-cause death (AD), MI, and heart failure (HF), referred to as a major adverse cardiovascular endpoint (MACE). Then, each variable was analyzed as a secondary outcome. Follow-up echocardiography identified 26 patients (9.9%) with LVR. LVR was associated with an initial LV ejection fraction <50%, Killip 3 disease at presentation, and a peak troponin I level >70 mg/dL. Survival analysis showed an association between LVR and adverse outcomes only in the IR group, in which the adjusted hazard ratio (HR) was increased for the MACE (HR = 3.22, 95% confidence interval (CI) = 1.19-8.71, p = 0.002) and HF (HR = 21.37, 95% CI = 4.47-102.09, p< 0.001), but not for the CR group. In STEMI with MVD, LVR within the first year after percutaneous coronary intervention was associated with worse outcomes in the IR but not the CR group.
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