Role of stroke volume in patients presenting with uncomplicated anterior STEMI.

Abstract

Background: Stroke volume is an established echocardiographic marker but has not been widely studied in patients with ST-segment elevation myocardial infarction (STEMI). We aimed to evaluate stroke volume in a cohort of uncomplicated anterior STEMI and to assess its prognostic role in those with severe left ventricle (LV) systolic dysfunction.

Methods and results: This is a single-centre retrospective analysis of consecutive patients presenting with anterior STEMI who underwent uncomplicated primary percutaneous coronary intervention. Stroke volume was measured using echocardiography within in-hospital admission. The primary endpoint was cardiovascular mortality. Of 3592 patients with STEMI, 616 were included. The mean age was 65±14 years (76% males). The average left ventricular ejection fraction (LVEF) and stroke volume were 39±11% and 62±18 mL, respectively. There was a modest relationship between stroke volume and LVEF (r=0.33, p<0.001), which was not maintained in patients with severe LV dysfunction (r=0.11, p=0.19). On multivariate analysis, stroke volume was associated with cardiovascular death at 12 months (HR 0.92, 95% CI 0.86 to 0.98, p=0.015) in patients with severe LV systolic dysfunction. Receiver operating characteristic analysis demonstrated an area under the curve of 0.80 (95% CI 0.70 to 0.91, p<0.001) in this group with negative predictive value of 99% for cardiovascular mortality.

Conclusions: Stroke volume is a readily and useful echocardiographic marker to assess prognosis in patients with anterior STEMI and severe LV systolic dysfunction. It identifies with a high degree of certainty those patients who are likely to survive despite their severe LV systolic dysfunction.