The 2016 European Society of Cardiology Guidelines introduced a new term, mid-range
left ventricular ejection fraction (mrEF) heart failure, however, the clinical characteristics
and short-term outcomes in cardiogenic shock patients with mrEF after acute myocardial
infarction remain unclear. This retrospective study analyzed the baseline characteristics,
management, and outcomes according to the left ventricular ejection fraction (LVEF),
reduced LVEF (rEF) ≤40%, mrEF 41% to 49%, and preserved LVEF (pEF) ≥50% in patients
with acute myocardial infarction complicated by cardiogenic shock. The primary end
point was 30-day all-cause mortality and the secondary end point was the composite
events of major adverse cardiovascular events (MACEs). In 218 patients, 71 (32.6%)
were patients with mrEF. Compared with those with pEF, patients with mrEF had some
similar clinical characteristics to that of rEF. The 30-day all-cause mortality in
patients with rEF, mrEF, and pEF were 72.7%, 56.3%, and 32.0%, respectively (p = 0.001).
The 30-day MACE were 90.9%, 69.0%, and 60.2%, respectively (p = 0.001). After multivariable
adjustment, patients with mrEF and rEF had comparable 30-day all-cause mortality (hazard
ratio [HR] = 0.81, 95% confidence interval [CI] 0.50 to 1.33, p = 0.404), and pEF
was associated with decreased risk of 30-day all-cause mortality compared with rEF
(HR = 0.41, 95% CI 0.24 to 0.71, p = 0.001). In contrast, the risk of 30-day MACE
in mrEF and pEF were lower than that of rEF (HR = 0.62, 95% CI 0.40 to 0.96, p = 0.031
and HR = 0.53, 95% CI 0.34 to 0.80, p = 0.003, respectively). In conclusion, 1/3 of
patients with acute myocardial infarction complicated by cardiogenic shock were mrEF.
The clinical characteristics and short-term mortality in patients with mrEF were inclined
to that of rEF and the occurrence of early left ventricular systolic dysfunction is
of prognostic significance.
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Article Info
Publication History
Published online: January 02, 2022
Received in revised form:
November 13,
2021
Received:
September 3,
2021
Footnotes
Drs. Jiang and Boris contributed equally to this manuscript.
Supported by Chongqing Municipal Health Committee Projects (Chongqing, China), number 2020FYYX030 and dyslipidemia and atherosclerosis fund of China Heart House-China Cardiovascular Association (Jiangsu, China) number 2017-CCA-Msdlipid-015.
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