In low-income countries, reduced LVEF, common in STEMI, confers poor outcomes

August 22, 2022

2 minute read


Disclosures: Qamar and Gupta do not report any relevant financial information. Please see the study for relevant financial information from other authors.

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In a cohort of STEMI patients in India, reduced left ventricular ejection fraction was common and associated with mortality, and treatment compliance at 1 year was low, the researchers reported.

“Since there is a significant delay between the onset of symptoms and presentation to the hospital of STEMI in India, and there is also a delay when patients receive PCI, we have planned that a large proportion of patients will suffer myocardial damage and develop heart failure. Thus, we sought to examine the severity of LV dysfunction in patients with STEMI in India,” Arman Qamar, MD, MPH, said Healio, interventional cardiologist and adjunct researcher at the NorthShore Cardiovascular Institute, NorthShore Health System, Evanston, Illinois. “Since, according to our findings, more than 50% of patients with STEMI in India will develop heart failure, we hope this will increase awareness to seek immediate medical care and receive PCI in a timely manner. Moreover, this work will alarm the government to improve the STEMI care infrastructure in India (ambulance, drugs, stents and hospitalizations).”

Graphical representation of the source citation presented in the article
Qamar is an Interventional Cardiologist and Adjunct Researcher at the NorthShore Cardiovascular Institute.


Kamar, Mohit D. Gupta, MD, DM (Cardiology), FRCP (Edin), FACC, FSCAI, FESC, FCSI, FAPI, professor of cardiology at GB Pant Institute of Post Graduate Medical Education and Research New Delhi, and colleagues analyzed 3,597 patients from the NORIN-STEMI registry, which includes adults with STEMI at two tertiary centers in Delhi, India.

Of the cohort, 13% had an LVEF >50%, 41% had an LVEF between 40% and 49%, 38% had an LVEF of 30% to 39%, and 8% had an LVEF less than 30%, according to the researchers. .

Factors associated with lower LVEF included presentation delay of more than 24 hours, prior MI and hyperlipidemia, the researchers wrote.

While most patients were discharged with guideline-recommended drugs, adherence at 1 year was poor, Qamar, Gupta and colleagues found, noting that 91% of patients were discharged with an ACE inhibitor. or an angiotensin receptor antagonist, but 41% adhered to it at 1 year; 98% of patients left on beta-blocker but 78% adhered to it at 1 year; and 69% were released on aldosterone receptor antagonist and 6% adhered to it at 1 year.

Low LVEF and Mortality

After multivariate adjustment, compared to LVEF >50%, LVEF 30%-39% (aHR=1.77; 95% CI, 1.2-2.6) and LVEF

“Note that patients pay cash for stents in India, and a large number of patients decide to let the heart muscle die because they have no money to pay,” Qamar told Healio. “It’s very unfortunate.”

The findings suggest that systematic initiatives are needed to improve STEMI care in low-income countries, the researchers wrote.

“We need to increase awareness of heart attack symptoms and signs so that patients can get timely medical care before it’s too late,” Qamar told Healio. “We also want to work with the government to increase the availability of health centers with fibrinolysis and primary PCI capacity. [Guideline-directed medical therapy] for STEMI and heart failure should be available free of charge to patients who cannot afford to buy them. We plan to do this with a public-private partnership.

For more information:

Arman Qamar, MD, MPH, can be reached at [email protected]; Twitter: @aqamarmd.

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