The following is a summary of “Patients With AMI and Severely Reduced LVEF, a Well-Defined, Still Extremely Vulnerable Population (Insights from AMIS Plus Registry),” published in the August 2023 issue of the Cardiovascular Disease by Roberto et al.

The left ventricular ejection fraction (LVEF) is a significant indicator of both short-term and long-term outcomes in acute myocardial infarction (AMI) cases. Temporal trends data are scarce from real-world experiences that specifically concentrate on patients diagnosed with acute myocardial infarction (AMI) and exhibit a significantly diminished left ventricular ejection fraction (LVEF) of less than 30%. In a cohort of 48,543 individuals who underwent screening for acute myocardial infarction (AMI) and were included in the Acute Myocardial Infarction in Switzerland Plus Registry from 2005 to 2020, information regarding left ventricular ejection fraction (LVEF) was accessible for 23,510 patients. 

The study participants were categorized based on their left ventricular ejection fraction (LVEF) as individuals with acute myocardial infarction (AMI) either with or without significantly decreased LVEF (specifically, patients with LVEF less than 30% and patients with LVEF greater than or equal to 30%, respectively). About 1,657 patients diagnosed with acute myocardial infarction (AMI) exhibited a significantly decreased left ventricular ejection fraction (LVEF) of 7%. The incidence of severe left ventricular ejection fraction (LVEF) reduction consistently declined throughout the study (from 11% to 4%, P <0.001). In the subset of patients with severely reduced left ventricular ejection fraction (LVEF), there was a notable rise in the rate of revascularisation (from 61% to 84%, P <0.001). 

However, there was no significant decrease in in-hospital mortality, which remained consistently high at over 20% throughout the study (from 23% to 26%, P = 0.65). Upon discharge, the prescription of an optimal cardioprotective therapy, which consists of a combination of renin-angiotensin-aldosterone-system inhibitors, β-blockers, and mineral corticoid receptor antagonists, exhibited a consistently low rate throughout the study (increasing from 17% in 2011 to 20%, P = 0.96). In summary, individuals diagnosed with acute myocardial infarction (AMI) and experiencing a significant decrease in left ventricular ejection fraction (LVEF) continue to be a vulnerable subset of patients, with a mortality rate during their hospital stay that did not exhibit a significant decline and consistently remained higher than 20% throughout the study. Furthermore, the availability of optimal cardioprotective therapy upon discharge continues to be inadequate. Therefore, efforts are required to enhance prognosis and access to guidelines-directed medicines in this vulnerable population.

Source: sciencedirect.com/science/article/abs/pii/S0002914923003120