Predicting Irreversible Left Ventricular Dysfunction After Acute Myocardial Infarction

Patients with reduced left ventricular ejection fractions (LVEFs) and previous myocardial infarctions or heart failure are at increased mortality risk. Implantable cardioverter-defibrillators may mitigate this risk. The aim of this study was to identify patient characteristics at the time of presentation with ST elevation myocardial infarction (STEMI) that predict irreversible left ventricular dysfunction. From January 2003 to December 2005, patients presenting with STEMIs and an LVEFs after percutaneous coronary intervention ≤0.4 were included (n = 118). Clinical, angiographic, and electrocardiographic characteristics at the time of STEMI were evaluated to predict LVEF at ≥90 days. Multivariate analysis identified post–percutaneous coronary intervention LVEF ≤0.3 (odds ratio 5.4, 95% confidence interval 2.1 to 14.1, p = 0.001), presentation with Killip class >I (odds ratio 4.4, 95% confidence interval 1.5 to 12.6, p = 0.006), and Q waves on postrevascularization electrocardiography (odds ratio 6.3, 95% confidence interval 1.5 to 26.5, p = 0.011) to be significantly more common in the group with LVEFs ≤0.3 at ≥90 days. The presence of all 3 factors, present in 14 patients (12%), had a positive predictive value of 100% that LVEF would be ≤0.3 at ≥90 days. In conclusion, in patients with STEMIs referred for catheterization, a post–percutaneous coronary intervention LVEF ≤0.3, presentation with Killip class >I, and pathologic Q waves after revascularization each predicted that the LVEF measured at ≥90 days would remain ≤0.3. The presence of all 3 features had a positive predictive value of 100%. These findings may identify a high-risk group of patients who might benefit from early aggressive therapy such as an implantable cardioverter-defibrillator.