Clinical correlates of early post-PCI left ventricular ejection fraction in patients with STEMI: a single-center retrospective study.
TL;DR
In PCI-treated STEMI, LAD culprit territory and admission systolic blood pressure were the main clinical correlates of early post-PCI LV dysfunction, whereas TG/HDL-C showed only modest discrimination and limited standalone clinical utility.
Abstract
INTRODUCTION Early left ventricular systolic dysfunction after primary percutaneous coronary intervention (PCI) remains common in ST-segment elevation myocardial infarction (STEMI) and is associated with adverse remodeling and heart failure. The clinical relevance of lipid markers and lipid ratios for characterizing early post-PCI ventricular dysfunction beyond angiographic and hemodynamic features remains uncertain.
Methods
We conducted a single-center retrospective study of consecutive patients with STEMI undergoing emergency PCI at Nanjing BenQ Hospital (2014-2023). LVEF was assessed by transthoracic echocardiography 24-72 h post-PCI, and reduced LVEF was defined as < 50%. Lipids were measured from the first blood sample obtained on admission, and LDL-C/HDL-C and TG/HDL-C were calculated. Multivariable linear and logistic regression models with hierarchical adjustment (Model 2 additionally including log1p-transformed troponin I measured from the first blood sample obtained on admission) were used to identify factors associated with LVEF and reduced LVEF. Discrimination of lipid markers was evaluated using ROC analysis.
Results
Among 254 patients, 45 (17.7%) had reduced LVEF. LAD as the infarct-related artery (IRA) was more frequent in the reduced-LVEF group (73.3% vs. 48.3%, P = 0.002). LAD-IRA was independently associated with lower LVEF (β = -5.240; P < 0.001) and higher odds of reduced LVEF (OR = 4.005; P < 0.001). Higher systolic blood pressure was associated with lower odds of reduced LVEF (P = 0.026). TG/HDL-C showed modest discrimination (AUC = 0.605), whereas LDL-C showed no meaningful discrimination (AUC = 0.492).
Conclusion
In PCI-treated STEMI, LAD culprit territory and admission systolic blood pressure were the main clinical correlates of early post-PCI LV dysfunction, whereas TG/HDL-C showed only modest discrimination and limited standalone clinical utility. These findings should be considered exploratory and hypothesis-generating.