Recovery of left ventricular ejection fraction (LVEF) after ST-segment elevation myocardial infarction (STEMI) varies considerably among patients and remains difficult to predict in routine practice. In a retrospective analysis presented at the EuroPCR 2026, investigators evaluated clinical, angiographic, and echocardiographic factors associated with persistent LVEF dysfunction after first STEMI treated with primary percutaneous coronary intervention (PCI).
Patients with prior coronary artery disease, previous myocardial infarction or PCI, known left ventricular dysfunction, rescue PCI, or prior chemotherapy or radiation exposure were excluded to isolate the impact of the index STEMI event. Multivariable logistic regression analysis was performed to identify predictors of LVEF non-recovery.
Findings
- The study included 131 consecutive adults presenting with index STEMI
- At follow-up, 57% of patients had persistent LVEF ≤40%.
- Chest pain duration longer than 24 hours before hospital presentation was independently associated with persistent LVEF dysfunction (p<0.001).
- Higher SYNTAX score was associated with increased odds of LVEF non-recovery (p=0.01).
- Higher peak troponin I levels were also associated with persistent dysfunction (p=0.002).
- Patients with initial post-PCI LVEF ≥26% had significantly lower odds of persistent dysfunction compared with patients with initial LVEF <26%.
- Door-to-balloon time was not independently associated with long-term LVEF recovery.
- Culprit vessel location, ST-segment distribution on electrocardiography, and post-procedural TIMI flow were also not independently associated with recovery outcomes.
- Early post-PCI echocardiographic findings provided additional prognostic information regarding long-term ventricular recovery.
The findings suggest that prolonged symptom duration before presentation may have a greater influence on long-term left ventricular recovery after STEMI than door-to-balloon time alone. Angiographic disease complexity, infarct size markers, and early post-PCI ventricular function also appeared to contribute to persistent systolic dysfunction risk.
