Selvester score as a predictor of recovery in left ventricular systolic function following revascularization in STEMI patients with reduced ejection fraction

Abstract

Background: Patients with severe coronary disease may have varied degrees of left ventricular dysfunction, which is a prevalent cause of ischemic heart disease. Early detection of high-risk patients may help guide the use of therapy. Aim: The study aimed to predict left ventricular dysfunction improvement in patients with ST elevation myocardial infarction with reduced ejection fraction after successful reperfusion, identifying patients who require cardiac devices like cardiac resynchronization devices (CRT). Patents and methods: This study enrolled patients with acute ST elevation myocardial infarction and left ventricular systolic dysfunction. The study duration was from August 2022 to February 2023. Inclusion criteria included age >18, chest pain with ECG changes within 48 hours, or persistent symptoms suggesting ongoing myocardial ischemia or hemodynamic instability with LVSD. Exclusion criteria were STEMI >48 hours, reduced ejection fraction heart failure, congenital heart diseases, previous CABG, and patient refusal. Reperfusion was performed within 12 hours. The study measured Selvester Score and ejection fraction with echocardiography. Ethical considerations were in place for participant privacy. Results: Median symptom duration: 5.5 hours. Killip Class distribution: 46.3% Class I, 24.1% Class II, 13.0% Class III, 16.7% Class IV. Before treatment, mean EF was 30.78%, increased to 38.96% after 3 months. Selvester Score improved after 3 months. Factors associated with non-improvement: age above 58, male gender, diabetes, hypertension, dyslipidemia, family history of IHD, longer symptom/ischemic time, higher Killip Class, longer door-to-balloon time. Dyslipidemia and CKD associated with lower EF. Killip class and choice of P2Y12 inhibitor associated with EF. Patients with DM, HTN, dyslipidemia, and prior MI had higher Selvester scores. ROC analysis showed 85.71% sensitivity and 100.00% specificity for Selvester Score in detecting non-improvement. Conclusion: Our findings can help manage patients with STEMI during early hospitalization. Selvester QRS score may predict EF improvement and identify patients who may not benefit from early blockade. High-risk scores can signal the need for closer monitoring and assessment for post-infarction therapies.