Author + information
- Received July 9, 2019
- Revision received August 28, 2019
- Accepted August 29, 2019
- Published online December 11, 2019.
- Pieter van der Bijl, MBChB, MMeda,
- Rachid Abou, MDa,
- Laurien Goedemans, MDa,
- Bernard J. Gersh, MBChB, DPhilb,
- David R. Holmes Jr., MDb,
- Nina Ajmone Marsan, MD, PhDa,
- Victoria Delgado, MD, PhDa and
- Jeroen J. Bax, MD, PhDa,∗ ()
- aDepartment of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
- bDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- ↵∗Address for correspondence:
Dr. Jeroen J Bax, Department of Cardiology, Heart Lung Center, Leiden University Medical Center; Albinusdreef 2, 2300 RC Leiden, the Netherlands.
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 thrombolysis, whereas the long-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 (interquartile 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 STEMI is treated with primary PCI and optimal pharmacotherapy, almost one-half of patients demonstrate LV post-infarct remodeling. However, there is no difference in long-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.
The Department of Cardiology, Heart Lung Center, Leiden University Medical Center has received research grants from Biotronik, Medtronic, Boston Scientific, GE Healthcare, and Edwards Lifesciences. Drs. Ajmone Marsan, Delgado, and Bax have received speaker fees from Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 9, 2019.
- Revision received August 28, 2019.
- Accepted August 29, 2019.
- 2019 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.