Prevalence and prognostic implications of reduced left ventricular ejection fraction among patients with STEMI in India
Abstract 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...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-12-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.14055 |
| _version_ | 1797979241186328576 |
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| author | Michael J. Hendrickson Sameer Arora Muthiah Vaduganathan Gregg C. Fonarow Girish MP Ankit Bansal Vishal Batra Shekhar Kunal Deepak L. Bhatt Mohit Gupta Arman Qamar |
| author_facet | Michael J. Hendrickson Sameer Arora Muthiah Vaduganathan Gregg C. Fonarow Girish MP Ankit Bansal Vishal Batra Shekhar Kunal Deepak L. Bhatt Mohit Gupta Arman Qamar |
| author_sort | Michael J. Hendrickson |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-04-11T05:35:50Z |
| format | Article |
| id | doaj.art-6bbdc07a292c4672b0e41364bb7e69e8 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-04-11T05:35:50Z |
| publishDate | 2022-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-6bbdc07a292c4672b0e41364bb7e69e82022-12-22T12:55:33ZengWileyESC Heart Failure2055-58222022-12-01963836384510.1002/ehf2.14055Prevalence and prognostic implications of reduced left ventricular ejection fraction among patients with STEMI in IndiaMichael J. Hendrickson0Sameer Arora1Muthiah Vaduganathan2Gregg C. Fonarow3Girish MP4Ankit Bansal5Vishal Batra6Shekhar Kunal7Deepak L. Bhatt8Mohit Gupta9Arman Qamar10Massachusetts General Hospital, Harvard Medical School Boston MA USADivision of Cardiology University of North Carolina School of Medicine Chapel Hill NC USABrigham and Women's Hospital Heart and Vascular Institute Harvard Medical School Boston MA USADivision of Cardiology University of California Los Angeles Los Angeles CA USAGB Pant Institute of Postgraduate Medical Education and Research New Delhi IndiaGB Pant Institute of Postgraduate Medical Education and Research New Delhi IndiaGB Pant Institute of Postgraduate Medical Education and Research New Delhi IndiaGB Pant Institute of Postgraduate Medical Education and Research New Delhi IndiaBrigham and Women's Hospital Heart and Vascular Institute Harvard Medical School Boston MA USAGB Pant Institute of Postgraduate Medical Education and Research New Delhi IndiaSection of Interventional Cardiology and Vascular Medicine, NorthShore University Health System University of Chicago Pritzker School of Medicine Evanston IL USAAbstract 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.https://doi.org/10.1002/ehf2.14055ST‐elevation myocardial infarctionheart failureNORIN‐STEMIatherosclerotic cardiovascular diseaseleft ventricular dysfunction |
| spellingShingle | Michael J. Hendrickson Sameer Arora Muthiah Vaduganathan Gregg C. Fonarow Girish MP Ankit Bansal Vishal Batra Shekhar Kunal Deepak L. Bhatt Mohit Gupta Arman Qamar Prevalence and prognostic implications of reduced left ventricular ejection fraction among patients with STEMI in India ESC Heart Failure ST‐elevation myocardial infarction heart failure NORIN‐STEMI atherosclerotic cardiovascular disease left ventricular dysfunction |
| title | Prevalence and prognostic implications of reduced left ventricular ejection fraction among patients with STEMI in India |
| title_full | Prevalence and prognostic implications of reduced left ventricular ejection fraction among patients with STEMI in India |
| title_fullStr | Prevalence and prognostic implications of reduced left ventricular ejection fraction among patients with STEMI in India |
| title_full_unstemmed | Prevalence and prognostic implications of reduced left ventricular ejection fraction among patients with STEMI in India |
| title_short | Prevalence and prognostic implications of reduced left ventricular ejection fraction among patients with STEMI in India |
| title_sort | prevalence and prognostic implications of reduced left ventricular ejection fraction among patients with stemi in india |
| topic | ST‐elevation myocardial infarction heart failure NORIN‐STEMI atherosclerotic cardiovascular disease left ventricular dysfunction |
| url | https://doi.org/10.1002/ehf2.14055 |
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