After correcting for regression towards the mean, left ventricular ejection fraction in revascularized post-myocardial infarction patients showed only a moderate true increase of 2.0%.
Observational (n=277)
Yes
Does complete revascularization improve left ventricular ejection fraction in post-myocardial infarction patients with LVEF ≤40%?
Apparent large improvements in LVEF after revascularization in post-MI patients are largely due to regression towards the mean, with true recovery being minimal, suggesting single LVEF measurements are insufficient for ICD indication decisions.
Effect estimate: Mean difference 2.0% (95% CI 0.55-3.5)
p-value: p=0.007
BACKGROUND: Reduced left ventricular ejection fraction (LVEF) ≤30% is the most powerful prognostic indicator for sudden cardiac death (SCD) in patients after myocardial infarction (MI), but there are little data about long-term changes of LVEF after revascularization and the following implantation of a cardioverter defibrillator (ICD). METHODS: We performed a retrospective analysis of 277 patients with reduced LVEF at least 1 month after MI and complete revascularization. Patients (median time post-MI 23.4 months; 74.3% after PCI, 25.7% after CABG were assigned either to group 1 (LVEF <30%) or group 2 (LVEF 30-40%). Biplane echocardiography was redone after a mean follow-up of 441 ± 220 days. RESULTS: LVEF increased significantly in both two groups (group 1: 26.2 ± 4.8% to 32.4 ± 8.5%; p < 0.001; group 2: 38.2 ± 2.5% to 44.4 ± 9.6%; p < 0.001). However, statistical analysis of first and second LVEF measurement by means of a LOWESS regression and with an appropriate correction of the regression towards the mean effect revealed only a moderate increase of the mean LVEF from 35 to 37% (p < 0.001) with a large interindividual variation. CONCLUSIONS: The impact of early revascularization on LVEF appears to be low in the majority of post-MI heart failure patients. Owing to the high variability, a single measurement may not be reliable enough to justify a decision on ICD indication.
Reibis et al. (Wed,) conducted a observational in Post-myocardial infarction with reduced left ventricular ejection fraction (n=277). Complete revascularization (PCI or CABG) vs. Baseline LVEF was evaluated on True change in left ventricular ejection fraction (LVEF) after correction for regression towards the mean (Mean difference 2.0%, 95% CI 0.55-3.5, p=0.007). After correcting for regression towards the mean, left ventricular ejection fraction in revascularized post-myocardial infarction patients showed only a moderate true increase of 2.0%.