Predictors of major adverse cardiac events in post-myocardial infarction patients with heart failure with reduced ejection fraction
DOI:
https://doi.org/10.5281/zenodo.22814685Keywords:
myocardial infarction, heart failure, ejection fraction, major adverse cardiac events, risk predictionAbstract
Background: Patients who survive myocardial infarction but develop heart failure with reduced ejection fraction remain at substantial risk for recurrent major adverse cardiac events (MACE), despite advances in reperfusion and guideline-directed therapy.
Objective: This review synthesizes evidence on clinical, biochemical, imaging, and genetic predictors of MACE in post-myocardial infarction heart failure with reduced ejection fraction, and how these predictors inform risk stratification and treatment.
Methods: We reviewed cohort studies, randomized trial substudies, and meta-analyses addressing ejection fraction trajectory, natriuretic peptide and troponin trends, cardiac magnetic resonance infarct characteristics, renal function, arrhythmic markers, and risk-modifying therapy in this population.
Findings: Residual ejection fraction below 35%, rising NT-proBNP, larger infarct size and microvascular obstruction on cardiac magnetic resonance, reduced glomerular filtration rate, and nonsustained ventricular arrhythmia each independently predict MACE, while sacubitril-valsartan, mineralocorticoid receptor antagonists, SGLT2 inhibitors, and resynchronization or defibrillator therapy attenuate this risk.
Conclusions: Integrating clinical, biomarker, and imaging predictors into a longitudinal framework, rather than ejection fraction alone, offers the most promising path toward individualized surveillance and therapy intensification in this population.
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