# Short-term outcomes of non-ST segment elevation acute coronary syndrome after percutaneous coronary intervention: a single-center speckle tracking echocardiographic study in Vietnam

## TL;DR

This study shows that measuring heart muscle strain after a specific heart procedure can predict future heart problems in patients from Vietnam.

## Contribution

The study introduces the use of speckle-tracking echocardiography in a low- to middle-income country to predict adverse outcomes after PCI in NSTE-ACS patients.

## Key findings

- Global longitudinal strain (GLS) was the strongest predictor of major adverse cardiovascular events (MACE) after PCI.
- 20.5% of patients experienced MACE within 12 months of follow-up.
- Impaired GLS, GCS, and GRS were significantly associated with MACE.

## Abstract

Data on the prognostic value of myocardial strain in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) from low- and middle-income countries remain scarce. This study aimed to evaluate the prognostic significance of left ventricular myocardial strain in patients with NSTE-ACS after successful percutaneous coronary intervention (PCI) in Vietnam.

In this prospective cohort study, consecutive patients diagnosed with NSTE-ACS and treated with PCI underwent conventional and speckle-tracking echocardiography within 24 h post-PCI to assess myocardial function, including global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS). Patients were followed for 12 months. The association between echocardiographic parameters and major adverse cardiovascular events (MACE) was analyzed using Kaplan–Meier survival curves and Cox proportional hazards models. Prognostic performance was assessed using receiver operating characteristic (ROC) curves, area under the curve (AUC), and other diagnostic indices.

A total of 127 patients were included (mean age 65.5 ± 10.5 years; 71.3% male). During 12 months of follow-up, 26 patients (20.5%) experienced MACE. The MACE group had significantly impaired GLS, GCS, and GRS compared with the event-free group (all p < 0.0001). In multivariable analysis, only higher (less negative) GLS remained an independent predictor of MACE (HR: 1.62; 95% CI: 1.26–2.08; p < 0.001). GLS demonstrated the strongest prognostic performance among echocardiographic variables, with an AUC of 0.967 (95% CI: 0.941–0.994). At the optimal cutoff, an GLS ≥ –16% demonstrated a sensitivity of 100% (95% CI: 86.8–100) and a specificity of 85.1% (95% CI: 76.7–91.4).

In patients with NSTE-ACS, post-PCI GLS, GCS, and GRS were significantly more impaired in those who developed MACE compared with the event-free group, indicating underlying cardiac dysfunction or myocardial injury. Among these parameters, GLS emerged as an independent predictor of MACE after PCI and may serve as a valuable tool for identifying high-risk patients.

Infographic summarizing a study of 127 NSTE-ACS patients undergoing PCI, with 71.3% male and a mean age of 65.5±10.5 years. Speckle tracking echocardiography was performed within 24 hours post-PCI, and outcomes were followed for 12 months. Major adverse cardiovascular events (MACE) occurred in 26 patients (20.5%). Analyses included Kaplan-Meier (showing lower survival with GLS ≥−16%, P < 0.0001), multivariate Cox regression (GLS identified as the strongest MACE predictor; aHR 1.62 [1.26–2.08]), and ROC analysis (GLS AUC = 0.967), highlighting the prognostic value of global longitudinal strain.