TOPLINE:

In patients with first-time non-ST-segment elevation myocardial infarction (non-STEMI), a combination of reduced left ventricular ejection fraction (LVEF) and more extensive obstructive coronary artery disease (CAD) was associated with an increased risk for 5-year mortality.

METHODOLOGY:

• Researchers conducted a prospective study using data from a Danish registry to assess how LVEF and the extent of obstructive CAD jointly affected outcomes in non-STEMI.
• They included 8770 adults (median age range, 65-73 years; 65.9%-71.8% men) who underwent coronary angiography for non-STEMI with obstructive CAD for the first time between 2010 and 2021; patients were matched with 43,850 individuals from the general population.
• Patients were stratified on the basis of LVEF (> 50%, 41%-50%, and ≤ 40%). The extent of obstructive CAD was classified as single-, double-, or triple-vessel disease as per the number of affected vessels.
• The primary outcome was all-cause mortality, tracked from 30 days post-angiography through 5 years.

TAKEAWAY:

• Patients with LVEF ≤ 40% and triple-vessel disease had higher 5-year mortality than those with LVEF > 50% and single-vessel disease (adjusted hazard ratio [aHR], 3.05; 95% CI, 2.51-3.70), with an absolute risk difference of 37%.
• Patients with LVEF ≤ 40% and triple-vessel disease had a 24% higher absolute 5-year mortality risk than individuals from the general population.
• Considering LVEF alone, 5-year mortality was over twofold higher among patients with LVEF ≤ 40% than among those with LVEF > 50% (aHR, 2.32; 95% CI, 2.04-2.65); similarly, the risk for 5-year mortality was higher among those with triple-vessel disease than among those with single-vessel disease.

IN PRACTICE:

"The combined information from the LVEF assessment and the extent of obstructive CAD was associated with an increase in 5-year mortality, and a comparison with a matched general comparison cohort confirmed this relationship. [This] study thus provides valuable clinical knowledge for more precise risk stratification of patients with NSTEMI [non-STEMI]," the researchers reported.

SOURCE:

This study was led by Nina Stødkilde-Jørgensen, MD, Aarhus University Hospital, Aarhus, Denmark. It was published online on September 17, 2025, in JACC: Advances.

LIMITATIONS:

Individuals from the general population might have undiagnosed or subclinical cardiovascular disease, which may have influenced risk estimation. LVEF was measured only at a single timepoint. Without prior echocardiography, researchers could not distinguish whether reduced LVEF was preexisting or induced by non-STEMI.

DISCLOSURES:

This study received funding through a grant from the Novo Nordisk Foundation. Several authors reported receiving grants, lecture and/or advisory board fees, and travel grants and having other financial ties with multiple sources, including Novo Nordisk.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.