Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 143 No. 3536 (2013)

Prevalence of severely impaired left ventricular ejection fraction after reperfused ST-elevation myocardial infarction

  • David R. Altmann
  • Marcus Mutschelknauss
  • Niklas Ehl
  • Michael Koller
  • Beat Schär
  • Lucas Jörg
  • Peter Ammann
  • Michael Kühne
  • Hans Rickli
  • Stefan Osswald
  • Christian Sticherling
Cite this as:
Swiss Med Wkly. 2013;143:w13869


BACKGROUND: Preventive implantation of an implantable cardioverter defibrillator (ICD) early after myocardial infarction failed to demonstrate a survival benefit in patients with depressed left ventricular ejection fraction (LVEF). This may be explained by early recovery of the LVEF after percutaneous coronary intervention (PCI). We sought to determine the incidence of a sustained LVEF ≤35% in patients with severely depressed LVEF early after a revascularised acute ST-segment elevation myocardial infarction (STEMI).

METHODS: LVEF was assessed in patients with an acute STEMI treated with PCI in two Swiss high-volume centres within 10 days (in-hospital LVEF) after the STEMI. Those with an in-hospital LVEF ≤35% were scheduled for follow-up LVEF measurement within 6–8 weeks.

RESULTS: A total of 330 patients were included (79% male, mean age 63 ± 12 years). In-hospital LVEF measured 3 ± 3 days after STEMI was ≤35% in 32/330 patients (10%, 95% confidence interval (CI) 13%–67%). LVEF was available in 31/32 (97%) patients at follow-up 53 ± 19 days after STEMI and improved to >35% in 19 patients (61%, 95% CI 42%–78%). The incidence of a LVEF ≤35% at follow-up was 39% (12/31, 95% CI 22%–56%).

CONLUSION: Our data demonstrate that the incidence of severely impaired LV function 53 ± 19 days after a STEMI treated with PCI is low. A severely depressed LVEF early after STEMI was present in 10% of all patients. Only 39% of these patients had a persistently impaired LVEF during follow-up. These findings support an expectant strategy before considering primary preventive ICD implantation after STEMI.


  1. Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA 3rd, Freedman RA, Gettes LS et al. Acc/Aha/Hrs 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the Acc/Aha/Naspe 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008;51(21):e1–62.
  2. Moss AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H, et al. Improved Survival With an Implanted Defibrillator in Patients With Coronary Disease At High Risk for Ventricular Arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med. 1996;335(26):1933–40.
  3. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, et al. Prophylactic Implantation of a Defibrillator in Patients With Myocardial Infarction and Reduced Ejection Fraction. N Engl J Med. 2002;346(12):877–83.
  4. Antman EM, Hand M, Armstrong PW, Bates ER, Green LA, Halasyamani LK, et al. 2007 Focused Update of the Acc/Aha 2004 Guidelines for the Management of Patients With St-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the Canadian Cardiovascular Society Endorsed By the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With St-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee. Circulation. 2008;117(2):296–329.
  5. Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, et al. Acc/Aha 2007 Guidelines for the Management of Patients With Unstable Angina/Non St-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non St-Elevation Myocardial Infarction): Developed in Collaboration With the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons: Endorsed By the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. Circulation. 2007;116(7):e148–304.
  6. Hohnloser SH, Kuck KH, Dorian P, Roberts RS, Hampton JR, Hatala R, et al. Prophylactic Use of an Implantable Cardioverter-Defibrillator After Acute Myocardial Infarction. N Engl J Med. 2004;351(24):2481–8.
  7. Steinbeck G, Andresen D, Seidl K, Brachmann J, Hoffmann E, Wojciechowski D, et al. Defibrillator Implantation Early After Myocardial Infarction. N Engl J Med. 2009;361(15):1427–36.
  8. Ndrepepa G, Mehilli J, Martinoff S, Schwaiger M, Schomig A, Kastrati A. Evolution of Left Ventricular Ejection Fraction and Its Relationship to Infarct Size After Acute Myocardial Infarction. J Am Coll Cardiol. 2007;50(2):149–56.
  9. Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, et al. Management of Acute Myocardial Infarction in Patients Presenting With Persistent St-Segment Elevation: The Task Force on the Management of St-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J. 2008;29(23):2909–45.
  10. Thygesen K, Alpert JS, and White HD. Universal Definition of Myocardial Infarction. Eur Heart J. 2007;28(20):2525–38.
  11. Morrow DA, Antman EM, Charlesworth A, Cairns R, Murphy SA, de Lemos JA, et al. Timi Risk Score for St-Elevation Myocardial Infarction: A Convenient, Bedside, Clinical Score for Risk Assessment At Presentation: An Intravenous Npa for Treatment of Infarcting Myocardium Early Ii Trial Substudy. Circulation. 2000;102(17):2031–7.
  12. Atary JZ, Borleffs CJ, Liem SS, Bax JJ, van der Hoeven BL, Bootsma M, et al. Structured Care for Patients After Acute Myocardial Infarction: Sudden Cardiac Death Prevention – Data From the Leiden Mission! Ami Study. Europace. 2010;12(3):378–84.
  13. Huikuri HV, Raatikainen MJ, Moerch-Joergensen R, Hartikainen J, Virtanen V, Boland J, et al. Prediction of Fatal Or Near-Fatal Cardiac Arrhythmia Events in Patients With Depressed Left Ventricular Function After an Acute Myocardial Infarction. Eur Heart J. 2009;30(6):689–98.
  14. Ottervanger JP, Ramdat Misier AR, Dambrink JH, de Boer MJ, Hoorntje JC, Gosselink AT, et al. Mortality in Patients With Left Ventricular Ejection Fraction =30% After Primary Percutaneous Coronary Intervention for St-Elevation Myocardial Infarction. Am J Cardiol. 2007;100(5):793–7.
  15. Zabel M, Hohnloser SH, Koster W, Prinz M, Kasper W, Just H. Analysis of Creatine Kinase, Ck-Mb, Myoglobin, and Troponin T Time-Activity Curves for Early Assessment of Coronary Artery Reperfusion After Intravenous Thrombolysis. Circulation. 1993;87(5):1542–50.
  16. Lund GK, Stork A, Muellerleile K, Barmeyer AA, Bansmann MP, Knefel M, et al. Prediction of Left Ventricular Remodeling and Analysis of Infarct Resorption in Patients With Reperfused Myocardial Infarcts By Using Contrast-Enhanced Mr Imaging. Radiology. 2007;245(1):95–102.
  17. Hassan AK, Bergheanu SC, Hasan-Ali H, Liem SS, van der Laarse A, Wolterbeek R, et al. Usefulness of Peak Troponin-T to Predict Infarct Size and Long-Term Outcome in Patients With First Acute Myocardial Infarction After Primary Percutaneous Coronary Intervention. Am J Cardiol. 2009;103(6):779–84.
  18. Turer AT, Mahaffey KW, Gallup D, Weaver WD, Christenson RH, Every NR, et al. Enzyme Estimates of Infarct Size Correlate With Functional and Clinical Outcomes in the Setting of St-Segment Elevation Myocardial Infarction. Curr Control Trials Cardiovasc Med. 2005;6:12.
  19. Nienhuis MB, Ottervanger JP, de Boer MJ, Dambrink JH, Hoorntje JC, Gosselink AT, et al. Prognostic Importance of Creatine Kinase and Creatine Kinase-Mb After Primary Percutaneous Coronary Intervention for St-Elevation Myocardial Infarction. Am Heart J. 2008;155(4):673–9.
  20. Hamdan A, Kornowski R, Solodky A, Fuchs S, Battler A, Assali AR. Predictors of Left Ventricular Dysfunction in Patients With First Acute Anterior Myocardial Infarction Undergoing Primary Angioplasty. Isr Med Assoc J. 2006;8(8):532–5.
  21. Zaman S, Sivagangabalan G, Narayan A, Thiagalingam A, Ross DL, Kovoor P. Outcomes of Early Risk Stratification and Targeted Implantable Cardioverter-Defibrillator Implantation After St-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention. Circulation. 2009;120(3):194–200.
  22. Song YB, Hahn JY, Gwon HC, Kim JH, Lee SH, Jeong MH. The Impact of Initial Treatment Delay Using Primary Angioplasty on Mortality Among Patients With Acute Myocardial Infarction: From the Korea Acute Myocardial Infarction Registry. J Korean Med Sci. 2008;23(3):357–64.
  23. Dorian P, Hohnloser SH, Thorpe KE, Roberts RS, Kuck KH, Gent M, et al. Mechanisms Underlying the Lack of Effect of Implantable Cardioverter-Defibrillator Therapy on Mortality in High-Risk Patients With Recent Myocardial Infarction: Insights From the Defibrillation in Acute Myocardial Infarction Trial (Dinamit). Circulation. 2010;122(25):2645–52.
  24. Reichlin T, Hochholzer W, Bassetti S, Steuer S, Stelzig C, Hartwiger S, et al. Early Diagnosis of Myocardial Infarction With Sensitive Cardiac Troponin Assays. N Engl J Med. 2009;361(9):858–67.
  25. Cuculi F, De Caterina AR, Kharbanda RK, Banning AP. Optimal Reperfusion in St-Elevation Myocardial Infarction – the Role of the Coronary Microcirculation. Swiss Med Wkly. 2011;141:w13313.

Most read articles by the same author(s)

<< < 1 2 3 4 > >>