What is the clinical evidence from this study?

Study design: Cohort. Population: ST-elevation myocardial infarction (STEMI) (n=925). Intervention: Left ventricular ejection fraction (LVEF) assessment. Primary outcome: 3-year mortality (HR 1.28, 95% CI 1.14-1.44, p=<0.001).

February 23, 2008Open Access

The importance of left ventricular function for long-term outcome after primary percutaneous coronary intervention

Q: What are the key findings of this study?

Left ventricular ejection fraction assessed by planar radionuclide ventriculography is a powerful independent predictor of 3-year mortality after primary percutaneous coronary intervention for STEMI (HR 1.28 per 5% decrease).

Q: What does this research mean for the field?

Left ventricular ejection fraction assessed by planar radionuclide ventriculography is a powerful independent predictor of 3-year mortality after primary percutaneous coronary intervention for STEMI. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Left ventricular ejection fraction assessed by planar radionuclide ventriculography is a powerful independent predictor of 3-year mortality after primary percutaneous coronary intervention for STEMI (HR 1.28 per 5% decrease).

Study Design

Type

Cohort (n=925)

Multicenter

Yes

Structured PICO

Does left ventricular ejection fraction assessed by planar radionuclide ventriculography predict long-term mortality in patients treated with primary percutaneous coronary intervention for STEMI?

Population

925 patients treated with primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI), mean age 59.8 years, 77.8% male, based in the Netherlands.

Intervention

Left ventricular ejection fraction (LVEF) assessment by planar radionuclide ventriculography (PRV) using 500 Mbq of 99mTc-pertechnetate before hospital discharge (median 2 days after PPCI)

Outcome

1-year and 3-year all-cause mortalityhard clinical

LVEF assessed by planar radionuclide ventriculography shortly after PPCI for STEMI is a powerful independent predictor of long-term all-cause mortality.

Main Result

Effect estimate: HR 1.28 (95% CI 1.14-1.44)

p-value: p=<0.001

Limitations

Systematically excluded patients who were too hemodynamically unstable to undergo PRV
Relatively low event-rate for a post-infarction cohort
Used total mortality rather than cause-specific mortality

Abstract

BACKGROUND: In the present study we sought to determine the long-term prognostic value of left ventricular ejection fraction (LVEF), assessed by planar radionuclide ventriculography (PRV), after ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI). METHODS: In total 925 patients underwent PRV for LVEF assessment after PPCI for myocardial infarction before discharge from the hospital. PRV was performed with a standard dose of 500 Mbq of 99mTc-pertechnetate. Average follow-up time was 2.5 years. RESULTS: Mean (+/- SD) age was 60 +/- 12 years. Mean (+/- SD) LVEF was 45.7 +/- 12.2 %. 1 year survival was 97.3 % and 3 year survival was 94.2 %. Killip class, multi vessel-disease, previous cardiovascular events, peak creatin kinase and its MB fraction, age and LVEF proved to be univariate predictors of mortality. When entered in a forward conditional Cox regression model age and LVEF were independent predictors of 1 and 3 year mortality. CONCLUSION: LVEF assessed by PRV is a powerful independent predictor of long term mortality after PPCI for STEMI.

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