While routine assessment of LVEF may be challenged in subjects with minimal myocardial damage as determined by novel biomarkers, our findings apply to MIs ascertained using CK/CK-MB only, as troponin was not used in Olmsted County at that time. The racial and ethnic composition of Olmsted County is becoming more diverse, but during the study period more limited diversity may limit the generalization of these data to groups underrepresented in the population. Conversely, however, the quasi totality of the population has some form of health insurance such that confounding by access to care is unlikely to explain the present results.
Measurement of LVEF after MI increased the last 2 decades, but there continues to be a group of patients in whom it is not done. Given the potential benefits of LVEF measurement, including knowledge for risk stratification and therapeutic choices as underscored in recent practice guidelines, there may be additional opportunities for improving outcomes by ensuring its more consistent use. However, as testing for LVEF differs according to patient characteristics, reliance on selected clinically performed LVEF measurements will result in biased estimates of the prevalence of LV dysfunction after MI.