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Arch Iran Med. 2023;26(2): 92-99.
doi: 10.34172/aim.2023.15
PMID: 37543929
PMCID: PMC10685896
Scopus ID: 85164786781
  Abstract View: 875
  PDF Download: 474

Original Article

Determinants of Left Ventricular Systolic Function One Year after Primary Percutaneous Coronary Intervention for ST-elevation Myocardial Infarction in a Middle-Income Country

Reza Heidari Moghadam 1 ORCID logo, Nahid Salehi 1, Susan Mahmoudi 1, Lida Shojaei 1, Sirus Nasiri 1, Soraya Siabani 2, Parisa Janjani 1, Mohammad Rouzbahani 1, Hooman Tadbiri 1, Mahdi Nalini 1* ORCID logo

1 Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Imam Ali Hospital, Kermanshah, Iran
2 Department of Health Education and Health Promotion, Kermanshah University of Medical Sciences, Kermanshah, Iran
*Corresponding Author: Mahdi Nalini, Email: mahdinalini@yahoo.com

Abstract

Background: Little is known about the predictors of left ventricular ejection fraction (LVEF) —an important predictor of mortality— after primary percutaneous coronary intervention (PCI) in low- and middle-income countries.

Methods: In a prospective cohort study at Imam Ali hospital, Kermanshah, Iran, we enrolled consecutive ST-elevation myocardial infarction (STEMI) patients treated with primary PCI (2016-2018) and followed them up to one year. LVEF levels were measured by echocardiography, at baseline and one-year follow-up. Determinants of preserved/improved LVEF were assessed using multi-variable logistic regression models.

Results: Of 803 patients (mean age 58.53±11.7 years, 20.5% women), baseline LVEF levels of ≤35% were reported in 44%, 35- 50% in 40%, and ≥50% in 16% of patients. The mean ± SD of LVEF increased from 38.13%±9.2% at baseline to 41.49%±9.5% at follow-up. LVEF was preserved/improved in 629 (78.3%) patients. Adjusted ORs (95% CIs) for predictors of preserved/improved LVEF showed positive associations with creatinine clearance, 1.01 (1.00-1.02) and adherence to clopidogrel, 2.01 (1.33-3.02); and inverse associations with history of myocardial infarction (MI), 0.44 (0.25-0.78); creatine kinase MB (CK-MB), 0.997 (0.996- 0.999); door-balloon time (3rd vs. 1st tertile), 0.62 (0.39-0.98); number of diseased vessels (2 and 3 vs. 1: 0.63 (0.41-0.99) and 0.58 (0.36-0.93), respectively); and baseline LVEF (35-50% and ≥50% vs. ≤35%: 0.45 (0.28-0.71) and 0.19 (0.11-0.34), respectively).

Conclusion: Adherence to clopidogrel, short door-balloon time, high creatinine clearance, and lower baseline LVEF were associated with preserved/improved LVEF, while history of MI, high CK-MB, and multi-vessel disease were predictors of reduced LVEF. Long-term drug adherence should be considered for LVEF improvement in low- and middle-income countries.


Cite this article as: Heidari Moghadam R, Salehi N, Mahmoudi S, Shojaei L, Nasiri S, Siabani S, et al. Determinants of Left Ventricular Systolic Function One Year after Primary Percutaneous Coronary Intervention for ST-elevation Myocardial Infarction in a Middle-Income Country. Arch Iran Med. 2023;26(2):92-99. doi: 10.34172/aim.2023.15
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Submitted: 14 Mar 2022
Revision: 23 Jul 2022
Accepted: 28 Aug 2022
ePublished: 01 Feb 2023
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