Bae Min-Wook, Moon Seong-Guen, Jung Kyung-Tae, Kim Won-Ho, Park Sang-Hyun, Ahn Jihun, Hwang Jin-Yong, Oh Seok Kyu, Hur Seung Ho, Jung Myung Ho, Lee Kyu-Sun
Department of Internal Medicine and Cardiovascular Center, Daejeon Eulji University Hospital, Daejeon, Republic of Korea.
Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea.
Front Cardiovasc Med. 2025 May 14;12:1530006. doi: 10.3389/fcvm.2025.1530006. eCollection 2025.
The prognostic significance of changes in left ventricular ejection fraction (LVEF) and wall motion score index (WMSI) in patients with myocardial infarction remains unclear.
This study evaluated whether changes in LVEF and WMSI can predict clinical outcomes and LV remodeling in post-AMI patients. Using data from the Korea Acute Myocardial Infarction Registry-National Institutes of Health (KAMIR-NIH), 3,510 AMI patients who underwent percutaneous coronary intervention (PCI) were retrospectively analyzed. LVEF and WMSI were assessed via echocardiography at baseline and one-year post-PCI. The primary outcome was major cardiovascular adverse events (MACE), a composite of all-cause death, recurrent myocardial infarction (MI), and rehospitalization for heart failure at three years.
Among 3,510 AMI patients, 1,561 (44.5%) showed improvement in both LVEF and WMSI at one year after PCI, 1,150 (32.8%) experienced improvement in either LVEF or WMSI, while 799 (22.8%) had deterioration in both. The incidence of MACE was significantly lower in patients with improvement in both LVEF and WMSI (7.8% vs. 12.5% vs. 17.1%, < 0.001). These patients also exhibited the highest rate of LV reverse remodeling and the lowest rate of adverse remodeling. Both the random forest and logistic regression models identified changes in LVEF and WMSI as significant predictors of MACE and LV remodeling.
In AMI patients, improvement in both LVEF and WMSI post-PCI was associated with a lower risk of MACE and a higher likelihood of LV reverse remodeling. These findings highlight the prognostic value of LVEF and WMSI changes in guiding long-term management strategies.
心肌梗死患者左心室射血分数（LVEF）和壁运动评分指数（WMSI）变化的预后意义仍不明确。
本研究评估了LVEF和WMSI的变化是否能预测急性心肌梗死后（AMI）患者的临床结局和左心室重构。利用韩国急性心肌梗死注册研究-美国国立卫生研究院（KAMIR-NIH）的数据，对3510例行经皮冠状动脉介入治疗（PCI）的AMI患者进行了回顾性分析。在基线和PCI术后1年通过超声心动图评估LVEF和WMSI。主要结局是主要心血管不良事件（MACE），即3年时全因死亡、复发性心肌梗死（MI）和因心力衰竭再次住院的复合事件。
在3510例AMI患者中，1561例（44.5%）在PCI术后1年LVEF和WMSI均有改善，1150例（32.8%）LVEF或WMSI有改善，而799例（22.8%）两者均恶化。LVEF和WMSI均改善的患者MACE发生率显著较低（分别为7.8%、12.5%和17.1%，P<0.001）。这些患者还表现出最高的左心室逆向重构率和最低的不良重构率。随机森林模型和逻辑回归模型均将LVEF和WMSI的变化确定为MACE和左心室重构的重要预测因素。
在AMI患者中，PCI术后LVEF和WMSI均改善与较低的MACE风险和较高的左心室逆向重构可能性相关。这些发现突出了LVEF和WMSI变化在指导长期管理策略方面的预后价值。
