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SUMMARY OBJECTIVE: A decrease in the left ventricular ejection fraction (≤40%) in the setting of ST-segment elevation myocardial infarction is a significant predictor of mortality in the young ST-segment elevation myocardial infarction population. In this study, we aimed to investigate the predictors of left ventricular ejection fraction reduction and evaluate the long-term mortality rates in young ST-segment elevation myocardial infarction patients with or without decreased left ventricular ejection fraction. METHODS: We enrolled retrospectively 411 consecutive ST-segment elevation myocardial infarction patients aged 45 years or below who underwent primary percutaneous coronary intervention. Young ST-segment elevation myocardial infarction patients were divided into two groups according to their left ventricular ejection fraction (≤40%, n=72 and >40%, n=339), which were compared with each other. RESULTS: Statin use, white blood cell count, C-reactive protein, peak creatine kinase-MB, prolonged ischemia time, left anterior descending artery-related infarction, proximally/ostial located lesion, and no-reflow were independently associated with low left ventricular ejection fraction. Additionally, long-term mortality was considerably higher in the left ventricular ejection fraction ≤40% group than those in the left ventricular ejection fraction>40% group (18.1% versus 2.4%; p<0.001). CONCLUSIONS: In young ST-segment elevation myocardial infarction patients, lesion properties (left anterior descending lesion, proximally located lesion), no-reflow, and prolonged ischemia time appeared to be important determinants for the left ventricular ejection …