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Impact and determinants of left ventricular function in patients undergoing primary percutaneous coronary
Amir Halkin1, Gregg W Stone, Simon R Dixon
1Cardiovascular Research Foundation, New York, New York, USA.
Insights
Baseline left ventricular ejection fraction (LVEF) significantly impacts survival after acute myocardial infarction (AMI) treated with primary angioplasty. Early LVEF is a strong predictor of mortality and recovery, guiding prognosis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes
Background:
- Acute myocardial infarction (AMI) poses significant mortality risks.
- Primary angioplasty is a key treatment for AMI.
- Assessing left ventricular function is crucial for patient prognosis.
Purpose of the Study:
- To evaluate the prognostic effect of baseline left ventricular function after primary angioplasty for AMI.
- To identify determinants of left ventricular function recovery post-AMI.
Main Methods:
- Analysis of 1,620 patients from the CADILLAC trial undergoing primary angioplasty for AMI.
- Left ventriculography performed during the index procedure to assess baseline left ventricular ejection fraction (LVEF).
- Multivariate analysis to identify predictors of 1-year mortality and convalescent LVEF.
Main Results:
- Lower baseline LVEF (<40%) was associated with significantly lower 1-year survival rates (89.0% vs 97.2%).
- Baseline LVEF and infarct zone regional wall motion independently predicted 1-year mortality.
- Convalescent LVEF correlated with baseline LVEF, previous AMI, multivessel disease, and procedural factors.
Conclusions:
- Baseline left ventricular function is a strong independent predictor of early and late survival after primary angioplasty.
- Clinical and angiographic features available during primary angioplasty predict convalescent LVEF and have prognostic utility.
Abstract:
We evaluated the prognostic effect of baseline left ventricular function and the determinants of its recovery after acute myocardial infarction (AMI) treated by primary angioplasty. Left ventriculography was performed during the index procedure in 1,620 of 2,082 patients (78%) who underwent primary angioplasty for AMI in the CADILLAC trial. One-year survival rate was significantly lower in patients whose baseline left ventricular ejection fraction (LVEF) was <40% than in those whose LVEF was > or =40% (89.0% vs 97.2%, respectively, p <0.0001). The effect of baseline left ventricular dysfunction on mortality was confined to the first 3 months after AMI; thereafter, survival was independent of baseline LVEF. By multivariate analysis, baseline LVEF (hazard ratio 0.93, 95% confidence interval 0.90 to 0.97, p <0.001) and infarct zone regional wall motion (hazard ratio 2.67, 95% confidence interval 1.08 to 6.63, p = 0.03) were independent predictors of 1-year mortality. Seven-month convalescent LVEF was also directly related to baseline LVEF and inversely correlated with previous AMI, multivessel coronary disease, preprocedural Thrombolysis In Myocardial Infarction grade 0 to 2 flow, larger infarct artery diameter, and infarct artery restenosis at follow-up. In conclusion, baseline left ventricular function measured during the index procedure is a strong independent predictor of early and late survival after primary angioplasty. Simple clinical and angiographic features readily available at the time of primary angioplasty also predict convalescent LVEF and are thus of prognostic utility.
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