This study sought to investigate the impact of post-infarct left ventricular (LV) remodeling on outcomes in the contemporary era.
Background
LV remodeling after ST-segment elevation myocardial infarction (STEMI) is associated with heart failure and increased mortality. Pivotal studies have mostly been performed in the era of thrombolysis, whereas the long-term prognostic impact of LV remodeling has not been reinvestigated in the current era of primary percutaneous coronary intervention (PCI) and optimal pharmacotherapy.
Methods
Data were obtained from an ongoing registry of patients with STEMI (all treated with primary PCI). Baseline, 3-month, 6-month, and 12-month echocardiograms were analyzed. LV remodeling was defined as a ≥20% increase in LV end-diastolic volume at 3, 6, or 12 months post-infarct. The impact of LV remodeling on outcomes was analyzed.
Results
A total of 1,995 patients with STEMI were studied (mean age 60 ± 12 years, 77% men), 953 (48%) of whom demonstrated remodeling in the first 12 months of follow-up. After a median follow-up of 94 (interquartile range: 69 to 119) months, 225 (11%) patients had died. There was no difference in survival between remodelers and nonremodelers (p = 0.144). However, LV remodelers were more likely to be admitted to hospital for heart failure than were nonremodelers (p < 0.001).
Conclusions
In the contemporary era, in which STEMI is treated with primary PCI and optimal pharmacotherapy, almost one-half of patients demonstrate LV post-infarct remodeling. However, there is no difference in long-term survival between LV remodelers and nonremodelers, and LV remodelers experience a higher rate of heart failure hospitalization, which indicates the need to intensify preventative strategies in these patients.
Central Illustration
Key Words
LV remodeling
post-infarct
prognosis
Abbreviations and Acronyms
ACE
angiotensin converting enzyme inhibitor
ARB
angiotensin receptor blocker
ARNI
angiotensin receptor-blocker-neprilysin inhibitor
LV
left ventricle
LVEDV
left ventricular end-diastolic volume
LVEF
left ventricular ejection fraction
LVESV
left ventricular end-systolic volume
PCI
percutaneous coronary intervention
STEMI
ST-segment elevation myocardial infarction
WMSI
wall motion score index
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The Department of Cardiology, Heart Lung Center, Leiden University Medical Center has received research grants from Biotronik, Medtronic, Boston Scientific, GE Healthcare, and Edwards Lifesciences. Drs. Ajmone Marsan, Delgado, and Bax have received speaker fees from Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.