Prevalence, Predictors, And Prognostic Implications Of Left Ventricular Systolic Dysfunction Among Patients With Stemi In India: The Prospective Norin-Stemi Registry

Introduction: Left ventricular (LV) systolic dysfunction (LVSD) and HF are important complications of ST-elevation myocardial infarction (STEMI). The prevalence and prognostic implications of LVSD in patients with STEMI in low/middle-income countries such as India are not well established. Methods: The present analysis was performed using data from the ongoing , prospective NORIN-STEMI registry of patients presenting with STEMI to 2 tertiary care medical centers in New Delhi, India from January to November 2019. LV ejection fraction (EF) was assessed at STEMI presentation using transthoracic echocardiography. Covariate-adjusted logistic regression models were constructed to evaluate the association of LVSD (mild: EF = 40-50%; moderate/severe: EF<40%; ref: EF>50%) with risk of in-hospital and 30-day mortality. Results: Among 3,635 patients with STEMI (age: 55[45-62], 33%≤50 years, 16% women), 1,489 (41%) had mild and 1,675 (46%) had moderate/severe LVSD on presentation. Patients with greater LVSD more commonly presented with anterior wall STEMI and had more frequent involvement of the left anterior descending artery as the culprit vessel. Among those with no, mild or moderate/severe LVSD, PCI was performed in 70% and 62% of patients, respectively. Hypertension, prior myocardial infarction, physical inactivity, greater time since symptom onset, and lower literacy levels were each independently associated with higher likelihood of LVSD. In adjusted analysis, LVSD was significantly associated with higher likelihood of in-hospital but not 30-day mortality ( See Table ). Conclusion: Among patients presenting to tertiary care centers in India with STEMI, LVSD is common, with 87% demonstrating LVEF<50%. LVSD was significantly associated with higher risk of in-hospital and 30-day mortality. Future studies are needed to determine if quality improvement efforts to standardize pathways for primary PCI may lessen occurrence of LVSD.