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Left ventricular ejection fraction to predict early mortality in patients with non-ST-segment elevation acute coronary syndromes.
Am Heart J. 2005 Aug; 150(2):215-20.AH

Abstract

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.

Authors+Show Affiliations

Institut de Malalties Cardiovasculars, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

16086920

Citation

Bosch, Xavier, and Pierre Théroux. "Left Ventricular Ejection Fraction to Predict Early Mortality in Patients With non-ST-segment Elevation Acute Coronary Syndromes." American Heart Journal, vol. 150, no. 2, 2005, pp. 215-20.
Bosch X, Théroux P. Left ventricular ejection fraction to predict early mortality in patients with non-ST-segment elevation acute coronary syndromes. Am Heart J. 2005;150(2):215-20.
Bosch, X., & Théroux, P. (2005). Left ventricular ejection fraction to predict early mortality in patients with non-ST-segment elevation acute coronary syndromes. American Heart Journal, 150(2), 215-20.
Bosch X, Théroux P. Left Ventricular Ejection Fraction to Predict Early Mortality in Patients With non-ST-segment Elevation Acute Coronary Syndromes. Am Heart J. 2005;150(2):215-20. PubMed PMID: 16086920.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Left ventricular ejection fraction to predict early mortality in patients with non-ST-segment elevation acute coronary syndromes. AU - Bosch,Xavier, AU - Théroux,Pierre, PY - 2003/10/31/received PY - 2004/09/20/accepted PY - 2005/8/10/pubmed PY - 2005/12/13/medline PY - 2005/8/10/entrez SP - 215 EP - 20 JF - American heart journal JO - Am Heart J VL - 150 IS - 2 N2 - 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. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/16086920/Left_ventricular_ejection_fraction_to_predict_early_mortality_in_patients_with_non_ST_segment_elevation_acute_coronary_syndromes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(04)00659-3 DB - PRIME DP - Unbound Medicine ER -