E/e' in relation to outcomes in ST-elevation myocardial infarction
Sarah B Tai1, Wei Ren Lau1, Fei Gao2
1Ministry of Health Holdings, Singapore City, Singapore.
Insights
E/e
Area of Science:
- Cardiology
- Echocardiography
- Myocardial Infarction
Background:
- Myocardial infarction (MI) poses significant risks, particularly with elevated filling pressures.
- Previous studies suggest E/e' correlates with poor outcomes in MI patients.
- The comparative predictive value of E/e' versus Left Ventricular Ejection Fraction (LVEF) in MI risk stratification remains unclear.
Purpose of the Study:
- To investigate the predictive capability of E/e' compared to LVEF for short-term and long-term outcomes in ST-elevation Myocardial Infarction (STEMI) patients.
- To determine if E/e' offers superior risk prediction over LVEF in the context of primary percutaneous coronary intervention.
Main Methods:
- A cohort of 660 STEMI patients undergoing primary percutaneous coronary intervention was studied.
- E/e' was assessed in relation to short-term (in-hospital) mortality and 2-year composite outcomes (MI, stroke, heart failure, death) and all-cause death.
- Statistical models were adjusted for clinical and demographic factors, including LVEF.
Main Results:
- Elevated E/e' (>15) was significantly associated with increased short-term mortality risk (aOR 3.7).
- While E/e' showed association with long-term composite events and death, this significance was lost after multivariable adjustment.
- Left Ventricular Ejection Fraction (LVEF) emerged as a highly significant predictor of long-term outcomes in adjusted models.
Conclusions:
- E/e' is linked to adverse outcomes in STEMI patients, particularly in the short term.
- Left Ventricular Ejection Fraction (LVEF) demonstrates superior predictive power for long-term risk stratification in STEMI.
- Current clinical practice of using LVEF for risk assessment in STEMI is supported by these findings.
Background:
Myocardial infarction (MI) is a high-risk condition especially when filling pressure is raised, and earlier reports have suggested that E/e' is associated with poor outcome. However, whether E/e' predicts risk better than LVEF, which is the current standard of practice, is not known. We investigated this question in the largest and most rigorous study of MI patients so far.
Methods And Results:
We studied 660 patients with ST-elevation MI (STEMI) treated with primary percutaneous coronary intervention and related E/e' to short-term mortality (in-hospital death), as well as long-term events at 2 years comprising (a) a composite of MI, stroke, heart failure, and death, and (b) death alone. Short-term models were adjusted for age, sex, and LVEF. Long-term models were adjusted for age, sex, diabetes, revascularization procedure, history of MI, hypertension, renal function, drugs on discharge, and LVEF. Elevated E/e'> 15 indicated higher risk of short-term events (n = 19:7.0% (95% confidence interval 3.4-10.8%) vs. 1.0% (0.3 - 2.3%); adjusted odds ratio 3.7 (1.3-10.5)). While elevated E/e' was also associated with long-term outcomes (n = 103 composite events: 15.9% (11.9% - 21.4%) vs 6.8% (5.2% - 8.7%), P < .001; n = 38 death events: 6.0% (3.9% - 9.5%) vs 2.0% (1.3% - 3.2%), P = .001), E/e' was rendered nonsignificant for long-term outcomes by multivariable adjustment (p = ns for both). LVEF, on the contrary, was a highly significant predictor in the adjusted long-term model.
Conclusion:
E/e' is associated with poor outcome in STEMI, but LVEF is a stronger predictor of long-term risk.
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