Severe left ventricular dysfunction (LVEF < 30%) at admission in patients with acute coronary syndrome was associated with a 4.49-fold increased risk of 1-year mortality compared to preserved LV function.
Cohort (n=8,983)
Yes
What are the risk factors for 1-year mortality according to left ventricular ejection fraction (LVEF) at admission in patients with acute coronary syndrome?
LVEF at admission strongly predicts 1-year mortality in ACS, with clinical instability driving risk in severe LV dysfunction and comorbidities driving risk in preserved LVEF.
Effect estimate: HR 4.49 (95% CI 3.57-5.61)
Absolute Event Rate: 36% vs 4%
p-value: p=<0.001
There are limited data regarding factors affecting outcomes among acute coronary syndrome (ACS) patients presenting with varying degrees of left ventricle (LV) dysfunction. We aimed to identify factors associated with mortality according to LV ejection fraction (LVEF) at 1st admission in ACS patients.A total of 8983 ACS patients prospectively enrolled in the Acute Coronary Syndrome Israeli Survey (2000-2010) were categorized according to their LVEF at admission: severe LV dysfunction (LVEF < 30% n = 845), mild-moderate LV dysfunction (LVEF 30%-49% n = 4470); preserved LV function (LVEF ≥ 50% n = 3659). Multivariable Cox proportional hazards regression modeling was used to assess the risk factors for 1-year mortality according to LVEF on admission.Over the past decade there was a gradual decline in the proportion of patients admitted with low LVEF. Mortality rates were highest among patients with severe LV dysfunction (36%), intermediate among those with mild-moderate LV dysfunction (10%), and lowest among those with preserved LV function (4%, P < 0.001). We recognized different risk factors for mortality according to LVEF at admission. Admission clinical features (syncope, anterior myocardial infarction, and ST elevation myocardial infarction STEMI) predicted mortality risk in patients with severe LV dysfunction (all P < 0.05), whereas the presence of comorbidities (hypertension, diabetes mellitus, chronic renal failure, and peripheral arterial disease) predicted mortality risk in patients with more preserved LV function. Age and admission Killip class ≥II were consistent predictors in all LVEF subsets.LVEF at admission is a strong predictor of mortality in ACS, and prognostic factors differ according to LVEF during admission. In patients with severe LV dysfunction signs of clinical instability are related to 1-year mortality; in patients with a more preserved LV function the prognosis is related to the presence of co-morbidities.
Brezinov et al. (Wed,) conducted a cohort in Acute coronary syndrome (n=8,983). Severe left ventricular dysfunction (LVEF < 30%) vs. Preserved left ventricular function (LVEF ≥ 50%) was evaluated on 1-year all-cause mortality (HR 4.49, 95% CI 3.57-5.61, p=<0.001). Severe left ventricular dysfunction (LVEF < 30%) at admission in patients with acute coronary syndrome was associated with a 4.49-fold increased risk of 1-year mortality compared to preserved LV function.
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