Personalized Prediction of Left Ventricular Ejection Fraction in the Follow-Up of STEMI Patients: Development of a Practical Nomogram Model

Objective: Accurate estimation of left ventricular ejection fraction (LVEF) after ST-segment elevation myocardial infarction (STEMI) is essential for optimizing long-term management and cardiovascular risk stratification. This study aimed to identify predictors of LVEF at six months after STEMI and to develop a clinically applicable nomogram for individualized prognostic assessment.
Method: This prospective, single-center cohort study included consecutive patients admitted with STEMI between July 2018 and October 2018. Baseline clinical, laboratory, and angiographic variables were collected. LVEF was assessed by transthoracic echocardiography during index hospitalization and at six-month follow-up. Patients were categorized into four groups by follow-up LVEF. Predictors of six-month LVEF were identified using proportional odds logistic regression, and a nomogram was constructed from the final multivariable model.
Results: A total of 231 patients were analyzed (median age: 57 years; 83% male). At baseline, 119 patients (51%) had an LVEF <50%, whereas 115 patients (49%) had an LVEF <50% at six months. Multivariable analysis identified baseline LVEF, peak creatine kinase–myocardial band (CKMB) level, age, hypertension, and final Thrombolysis in Myocardial Infarction (TIMI) flow grade as independent predictors of follow-up LVEF (all p<0.05).
Conclusions: Baseline LVEF and peak CKMB level were the strongest independent predictors of six-month LVEF following STEMI. Age, hypertension, and final TIMI flow grade were also identified as additional predictors. The proposed nomogram offers a practical tool for individualized follow-up planning and risk assessment in STEMI survivors.

Keywords: Left ventricular ejection fraction, nomogram, ST elevation myocardial infarction