Different prognostic factors according to left ventricular systolic function in patients with acute myocardial infarction

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• 作者：Moon-Sun Im^a ; ¹ ; Hack-Lyoung Kim^a ; ¹ ; Sang-Hyun Kim^a ; ^{shkimmd@snu.ac.kr" class="auth_mail" title="E-mail the corresponding author} ; Woo-Hyun Lim^a ; Jae-Bin Seo^b ; Woo-Young Chung^a ; Joo-Hee Zo^a ; Myung-A Kim^a ; Kyung-Woo Park^b ; Bon-Kwon Koo^b ; Hyo-Soo Kim^b ; In-Ho Chae^c ; Dong-Ju Cho^c ; Youngkeun Ahn^d ; Myung Ho Jeong^d ; Other Korea Acute Myocardial Infarction Registry (KAMIR) ; Korea Working Group on Myocardial Infarction (KorMI) Investigators
• 关键词：Acute myocardial infarction ; Left ventricular systolic function ; Prognosis
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：15 October 2016
• 年：2016
• 卷：221
• 期：Complete
• 页码：90-96
• 全文大小：537 K

文摘

Initial left ventricular (LV) systolic function is a main determinant of clinical outcomes in patients with acute myocardial infarction (AMI). This study was performed to investigate whether AMI patients have different prognostic factors according to their baseline LV systolic function.

Methods

A total of 12,988 patients with AMI from a nationwide database were analyzed. Major adverse cardiovascular events (MACEs) within 12 months of AMI, including death, nonfatal myocardial infarction (MI), and revascularization, were assessed.

Results

Patients were stratified into two groups according to LV ejection fraction (LVEF): those with LVEF < 40% and those with LVEF ≥ 40%. Patients with LVEF < 40% (n = 1962, 15.1%) were older and had more unfavorable cardiovascular risk factors than those with LVEF ≥ 40% (n = 11,026, 84.9%). The rate of MACE was higher in patients with LVEF < 40% than in those with LVEF ≥ 40% (26.8% vs 11.4%, p < 0.001). Independent predictors of 12-month MACEs in patients with LVEF ≥ 40% were history of MI, high Killip stage, three-vessel disease, and lower renal function, which are already known as risk factors. However, diabetes mellitus (hazard ratio [HR], 1.68; 95% confidence interval [CI], 1.17–2.40; p = 0.008), and the use of rennin-angiotensin system (RAS) blockers (HR, 0.63; 95% CI, 0.41–0.95; p = 0.029) were independent factors for 12-month MACE in patients with LVEF < 40%.

Conclusions

Prognostic factors determining 12-month MACE after AMI are different according to LVEF. Management following AMI should be tailored according to their LV systolic function.