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Left ventricular ejection fraction to predict early mortality in patients with non-ST-segment elevation acute
1Institut de Malalties Cardiovasculars, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
Insights
Left ventricular ejection fraction (EF) significantly improves risk stratification for patients with non-ST-segment elevation acute coronary syndrome (ACS). Adding EF to the Thrombolysis in Myocardial Infarction (TIMI) risk score enhances prediction of in-hospital mortality.
Area of Science:
- Cardiology
- Clinical Medicine
- Cardiovascular Research
Background:
- Accurate risk stratification is crucial for optimal treatment of non-ST-segment elevation acute coronary syndrome (ACS).
- Current risk stratification models may not fully capture prognostic information.
- The role of left ventricular ejection fraction (EF) in refining ACS risk assessment requires further investigation.
Purpose of the Study:
- To evaluate the incremental prognostic value of routine left ventricular ejection fraction (EF) determination.
- To assess if EF improves risk stratification beyond established predictors in ACS patients.
- To determine the optimal EF cutoff for predicting in-hospital mortality.
Main Methods:
- A registry study of 1104 consecutive ACS patients with prospectively determined EF.
- Multiple regression models incorporating clinical, electrocardiographic, and biomarker stratifiers.
- EF values were added to established models to assess predictive improvement.
Main Results:
- Age, ST-segment shifts, cardiac markers, and TIMI risk score were significant mortality predictors (P < .0001).
- Inclusion of EF improved mortality prediction (C statistic 0.73 vs 0.67).
- A lower EF (<48%) was associated with significantly higher mortality rates across all TIMI risk strata.
Conclusions:
- The Thrombolysis in Myocardial Infarction (TIMI) risk score effectively predicts in-hospital mortality in ACS.
- Routine assessment of left ventricular ejection fraction (EF) provides significant additional prognostic information.
- EF measurement enhances the risk stratification of ACS patients, guiding more judicious treatment decisions.
Background:
Improvement in risk stratification of patients with non-ST-segment elevation acute coronary syndrome (ACS) is a gateway to a more judicious treatment. This study examines whether the routine determination of left ventricular ejection fraction (EF) adds significant prognostic information to currently recommended stratifiers.
Methods:
Several predictors of inhospital mortality were prospectively characterized in a registry study of 1104 consecutive patients, for whom an EF was determined, who were admitted for an ACS. Multiple regression models were constructed using currently recommended clinical, electrocardiographic, and blood marker stratifiers, and values of EF were incorporated into the models.
Results:
Age, ST-segment shifts, elevation of cardiac markers, and the Thrombolysis in Myocardial Infarction (TIMI) risk score all predicted mortality (P < .0001). Adding EF into the model improved the prediction of mortality (C statistic 0.73 vs 0.67). The odds of death increased by a factor of 1.042 for each 1% decrement in EF. By receiver operating curves, an EF cutoff of 48% provided the best predictive value. Mortality rates were 3.3 times higher within each TIMI risk score stratum in patients with an EF of 48% or lower as compared with those with higher.
Conclusions:
The TIMI risk score predicts inhospital mortality in a broad population of patients with ACS. The further consideration of EF adds significant prognostic information.
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