Left ventricular ejection fraction (LVEF) remains a critical predictor of outcomes in patients with non-ST-segment elevation myocardial infarction (NSTEMI), and chronic kidney disease (CKD) may modify this risk. At the European Society of Cardiology (ESC) 2025, a study leveraging the Korea Acute MI Registry-NIH assessed 4,567 NSTEMI patients over a three-year follow-up, stratified by CKD status and heart failure subtypes: HFrEF, HFmrEF, and HFpEF. 

In both CKD and non-CKD groups, HFrEF patients exhibited significantly higher all-cause and cardiac mortality than HFmrEF and HFpEF subgroups. Within the CKD cohort, mortality was similar between HFmrEF and HFpEF patients, whereas in non-CKD patients, HFmrEF showed elevated all-cause and cardiac death compared with HFpEF. The increased mortality in CKD patients with HFpEF contributed to these divergent patterns. 

These results highlight the complex interplay between renal function and LVEF in NSTEMI prognosis, suggesting that tailored strategies are needed for optimal risk management in patients with concomitant heart and kidney dysfunction.