Prevalence and prognostic implications of reduced left ventricular ejection fraction among patients with STEMI in India.

Hendrickson, Michael J; Arora, Sameer; Vaduganathan, Muthiah; Fonarow, Gregg C; Mp, Girish; Bansal, Ankit; Batra, Vishal; Kunal, Shekhar; Bhatt, Deepak L; Gupta, Mohit; Qamar, Arman

Hendrickson, Michael J; Arora, Sameer; Vaduganathan, Muthiah; Fonarow, Gregg C; Mp, Girish; Bansal, Ankit; Batra, Vishal; Kunal, Shekhar; Bhatt, Deepak L; Gupta, Mohit; Qamar, Arman.

Afiliación

Hendrickson MJ; Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Arora S; Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Vaduganathan M; Brigham and Women's Hospital Heart and Vascular Institute, Harvard Medical School, Boston, MA, USA.
Fonarow GC; Division of Cardiology, University of California Los Angeles, Los Angeles, CA, USA.
Mp G; GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
Bansal A; GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
Batra V; GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
Kunal S; GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
Bhatt DL; Brigham and Women's Hospital Heart and Vascular Institute, Harvard Medical School, Boston, MA, USA.
Gupta M; GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
Qamar A; Section of Interventional Cardiology and Vascular Medicine, NorthShore University Health System, University of Chicago Pritzker School of Medicine, Evanston, IL, USA.

ESC Heart Fail ; 9(6): 3836-3845, 2022 12.

Article en En | MEDLINE | ID: mdl-35950269

RESUMEN

AIMS: To describe clinical characteristics and outcomes for those with STEMI and reduced left ventricular ejection fraction (LVEF) in low-income and middle-income countries (LMICs). METHODS AND RESULTS: Adults presenting with STEMI to two government-owned tertiary care centres in Delhi, India were prospectively enrolled in the North India ST-elevation myocardial infarction (NORIN-STEMI) registry. LVEF was evaluated at presentation and clinical characteristics were compared across LVEF categories. Overall, 3597 patients were included, of whom 468 (13%) had LVEF >50%, 1482 (41%) had mildly reduced LVEF (40-49%), 1357 (38%) had moderately reduced LVEF (30-39%), and 290 (8%) had severely reduced LVEF (<30%). Presentation delay >24 h, prior MI, and hyperlipidaemia were associated with decreasing LVEF category. Although most patients with reduced LVEF were discharged on appropriate guideline-directed therapies, adherence at 1 year was low (ACE inhibitor/ARB 91% to 41%, beta blocker 98% to 78%, aldosterone receptor antagonist 69% to 6%). After multivariable adjustment, a Cox regression model showed moderately reduced LVEF (HR 1.77, 95% CI 1.20, 2.60) and severely reduced LVEF (HR 3.63, 95% CI 2.41, 5.48) were associated with increased risk of all-cause mortality compared with LVEF ≥50%. CONCLUSIONS: On presentation for STEMI, almost 90% of NORIN-STEMI participants had at least mildly reduced LVEF and almost half had LVEF <40%. Patients with LVEF <40% had significantly higher risk of mortality at 1 year, and adherence to guideline-directed therapies at 1 year was poor. Systematic initiatives to improve access to timely revascularization and guideline-directed therapies are essential in advancing STEMI care in LMICs.

Asunto(s)

Infarto del Miocardio con Elevación del ST; Humanos; Infarto del Miocardio con Elevación del ST/diagnóstico; Infarto del Miocardio con Elevación del ST/epidemiología; Infarto del Miocardio con Elevación del ST/terapia; Pronóstico; Función Ventricular Izquierda; Volumen Sistólico; Prevalencia; Antagonistas de Receptores de Angiotensina; Inhibidores de la Enzima Convertidora de Angiotensina

Palabras clave

NORIN-STEMI; ST-elevation myocardial infarction; atherosclerotic cardiovascular disease; heart failure; left ventricular dysfunction

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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Infarto del Miocardio con Elevación del ST Tipo de estudio: Guideline / Prevalence_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: ESC Heart Fail Año: 2022 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido

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