Left ventricular post-infarct remodeling implications for systolic function improvement and outcomes in the modern era

Abstract

OBJECTIVES This study sought to investigate the impact of post-infarct left ventricular (LV) remodeling on outcomes in the contemporary era.BACKGROUND LV remodeling after ST-segment elevation myocardial infarction (STEMI) is associated with heart failure and increased mortality. Pivotal studies have mostly been performed in the era of thrombotysis, whereas the tong-term prognostic impact of LV remodeling has not been reinvestigated in the current era of primary percutaneous coronary intervention (PCI) and optimal pharmacotherapy.METHODS Data were obtained from an ongoing registry of patients with STEMI (all treated with primary PCI). Baseline, 3-month, 6-month, and 12-month echocardiograms were analyzed. LV remodeling was defined as a >= 20% increase in LV end-diastolic volume at 3, 6, or 12 months post-infarct. The impact of LV remodeling on outcomes was analyzed.RESULTS A total of 1,995 patients with STEMI were studied (mean age 60 +/- 12 years, 77% men), 953 (48%) of whom demonstrated remodeling in the first 12 months of follow-up. After a median follow-up of 94 (interquartite range: 69 to 119) months, 225 (11%) patients had died. There was no difference in survival between remodelers and nonremodelers (p = 0.144). However, LV remodelers were more likely to be admitted to hospital for heart failure than were nonremodelers (p < 0.001).CONCLUSIONS In the contemporary era, in which STEMS is treated with primary PCI and optimal pharmacotherapy, almost one-half of patients demonstrate LV post-infarct remodeling. However, there is no difference in tong-term survival between LV remodelers and nonremodelers, and LV remodelers experience a higher rate of heart failure hospitalization, which indicates the need to intensify preventative strategies in these patients. (C) 2020 by the American College of Cardiology Foundation.