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Mortality in patients with left ventricular ejection fraction </=30% after primary percutaneous coronary intervention

Jan Paul Ottervanger1, Anand R Ramdat Misier, Jan-Henk E Dambrink

  • 1Department of Cardiology, Isala klinieken, Zwolle, The Netherlands. v.r.c.derks@isala.nl

The American Journal of Cardiology
|August 28, 2007
PubMed

Insights

Patients with reduced left ventricular (LV) function after heart attack and primary percutaneous coronary intervention have better survival than previously thought. This suggests a need to re-evaluate the routine use of implantable cardioverter-defibrillators (ICDs) in this population.

Area of Science:

  • Cardiology
  • Cardiovascular Medicine
  • Interventional Cardiology

Background:

  • Decreased left ventricular (LV) function is a significant predictor of mortality following myocardial infarction.
  • Current guidelines suggest prophylactic implantable cardioverter-defibrillator (ICD) implantation for patients with ST-elevation myocardial infarction and LV ejection fraction ≤30% after one month.
  • Improved reperfusion therapies and increased use of life-saving medications may alter the prognosis of these patients compared to historical ICD trials.

Purpose of the Study:

  • To prospectively assess the 1-year mortality rate in patients with depressed LV ejection fractions after primary percutaneous coronary intervention (PCI).
  • To compare current outcomes with historical data from randomized trials of ICDs in similar patient populations.

Main Methods:

  • A prospective, observational study was conducted.
  • Data were collected from patients who survived at least 30 days after primary PCI and had an LV ejection fraction (LVEF) of ≤30% between 1994 and 2004.
  • One-year mortality and causes of death were analyzed.

Main Results:

  • Out of 2,544 patients, 342 (13%) had an LVEF ≤30%.
  • The 1-year mortality rate in this cohort was 5.8%.
  • Sudden death was the most frequent cause of mortality (40%), often associated with multivessel disease and recurrent myocardial infarction within the first year.

Conclusions:

  • One-year mortality for patients with depressed LV function after primary PCI is lower than previously reported in major ICD trials.
  • The findings suggest that the benefits of prophylactic ICD therapy in this specific patient group warrant further investigation and re-evaluation.
  • Improved contemporary medical and interventional management may be contributing to better outcomes.

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