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Evaluation of acute myocardial infarction patients with mid-range ejection fraction after emergency percutaneous coronary intervention
  1. Yufeng Jiang,
  2. Shengda Hu,
  3. Mingqiang Cao,
  4. Xiaobo Li,
  5. Jing Zhou,
  6. Bing Ding,
  7. Fangfang Zhang,
  8. Tan Chen,
  9. Yafeng Zhou
  1. Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
  1. Correspondence to Dr Yafeng Zhou, Cardiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China; zhouyafeng73{at}


Background There is currently no classification for acute myocardial infarction (AMI) according to left ventricular ejection fraction (LVEF). We aimed to perform a retrospective analysis of patients undergoing emergency percutaneous coronary intervention (PCI), comparing the clinical characteristics, in-hospital acute heart failure and all-cause death events of AMI patients with mid-range ejection fraction (mrEF), preserved ejection fraction (pEF) and reduced ejection fraction (rEF).

Material and methods Totally 1270 patients were stratified according to their LVEF immediately after emergency PCI into pEF group (LVEF 50% or higher), mrEF group (LVEF 40%–49%) and rEF group (LVEF <40%). Kaplan-Meier curves and log rank tests were used to assess the effects of mrEF, rEF and pEF on the occurrence of acute heart failure and all-cause death during hospitalisation. The Cox proportional hazards model was used for multivariate correction.

Results Compared with mrEF, rEF was an independent risk factor for acute heart failure events during hospitalisation (HR 5.01, 95% CI 3.53 to 7.11, p<0.001), and it was also an independent risk factor for all-cause mortality during hospitalisation (HR 7.05, 95% CI 4.12 to 12.1, p<0.001); Compared with mrEF, pEF was an independent protective factor for acute heart failure during hospitalisation (HR 0.49, 95% CI 0.30 to 0.82, p=0.01), and it was also an independent protective factor for all-cause death during hospitalisation (HR 0.33, 95% CI 0.11 to 0.96, p=0.04).

Conclusions mrEF patients with AMI undergoing emergency PCI share many similarities with pEF patients in terms of clinical features, but the prognosis is significantly worse than that of pEF patients, suggesting that we need to pay attention to the management of mrEF patients with AMI.

  • acute myocardial infarction
  • early prognosis
  • mid-range ejection fraction

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  • YJ and SH contributed equally.

  • Contributors YJ and SH: main authors of the study, established the idea to study the mid-range ejection fraction patients of AMI in Chinese population. Writing main ideas for this research, main results and discussion of the findings. MC, XL, JZ and BD: interpreted statistical analysis and conducted multivariate analysis to prove the main findings of this project. YZ: corresponding author of the study, contributed on editing this manuscript and giving advice for the main authors to organise the manuscript and ideas of the project. FZ and TC: contributed with study methodology.

  • Funding This work was supported by grants from National Natural Science Foundation of China (81873486), Natural Scientific Fund of Jiangsu province (BK20161226), Jiangsu Province’s Key Provincial Talents Program (ZDRCA2016043), Jiangsu Province’s 333 High-Level Talents Project (BRA2017539).

  • Disclaimer The funders had no roles in study design, data collection and analysis, decision to publish or preparation of the manuscript.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Our study was approved by the ethics committee of the First Affiliated Hospital of Soochow University (IRB No.2018096).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.