Arrhythmic risk stratification in post-myocardial infarction patients with preserved ejection fraction: long-term outcomes from the PRESERVE EF study - Report - MDSpire
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Arrhythmic risk stratification in post-myocardial infarction patients with preserved ejection fraction: long-term outcomes from the PRESERVE EF study
Clinical Report: Risk Assessment for Arrhythmias in Post-Myocardial Infarction Patients
Overview
The PRESERVE EF study evaluated a two-step algorithm for risk stratification in post-myocardial infarction patients with preserved left ventricular ejection fraction (LVEF). Findings from an 8-year follow-up indicated that this approach identifies high-risk patients for major arrhythmic events.
Background
Post-myocardial infarction patients with preserved LVEF represent a significant clinical challenge due to the low but present risk of sudden cardiac death (SCD). Current guidelines primarily rely on LVEF for risk stratification, which has been shown to be inadequate in predicting SCD. The PRESERVE EF study introduces a multifactorial approach that may enhance risk assessment in this population.
Data Highlights
Parameter
Value
Sensitivity
100% (95% CI: 73.5%–100%)
Specificity
94.8% (95% CI: 92.5–96.5%)
Positive Predictive Value
29.3% (95% CI: 17.2–45.0%)
Negative Predictive Value
100% (95% CI: 99.3%–100%)
Key Findings
No sudden cardiac deaths were observed during the follow-up period.
12 ICD activations occurred, with a major arrhythmic event prevalence of 29.3% in patients with ICD implantation.
204 out of 575 patients (35.5%) had at least one positive non-invasive risk factor.
Events occurred only in patients with LVEF 40%–50% and a history of ST-Elevation Myocardial Infarction.
Of 152 patients undergoing programmed ventricular stimulation (PVS), 41 were inducible, and 37 (90.2%) received an ICD.
Clinical Implications
The findings suggest that a two-step, non-invasive risk factor-guided approach can effectively identify high-risk post-MI patients. This may inform clinical decision-making regarding the use of implantable cardioverter-defibrillators in this population.
Conclusion
The PRESERVE EF study highlights the potential of a structured risk assessment strategy in identifying post-MI patients at high risk for arrhythmic events, emphasizing the need for improved stratification methods beyond LVEF alone.
