Long‐term mortality after acute coronary syndromes among patients with normal, mildly reduced, or reduced ejection fraction

Long‐term mortality after acute coronary syndromes among patients with normal, mildly reduced, or reduced ejection fraction

Aims Left ventricular ejection fraction (LVEF) ≤ 40% is a well‐established risk factor for mortality after acute coronary syndromes (ACS). However, the long‐term prognostic impact of mildly reduced ejection fraction (EF) (LVEF 41–49%) after ACS remains less clear. Methods and results This was a retr...

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Published in:ESC Heart Failure Vol. 10; no. 1; pp. 442 - 452
Main Authors: Furtado, Remo H.M., Juliasz, Marcela G., Chiu, Felipe Y.J., Bastos, Livia B.C., Dalcoquio, Talia F., Lima, Felipe G., Rosa, Renato, Caporrino, Cesar A., Bertolin, Adriadne, Genestreti, Paulo R.R., Ribeiro, Andre S., Andrade, Maria Carolina, Giraldez, Roberto R.C.V., Baracioli, Luciano M., Zelniker, Thomas A., Nicolau, Jose C.
Format: Journal Article
Language:English
Published: England John Wiley & Sons, Inc 01-02-2023
Wiley
Subjects:
ACS
Acute Coronary Syndrome
Acute coronary syndromes
Beta blockers
Cardiovascular disease
Coronary vessels
Ejection fraction
Heart attacks
Heart Failure
Humans
Ischemia
Kidney diseases
Left ventricular ejection fraction
Long‐term mortality
Medical prognosis
Mildly reduced ejection fraction
Mortality
Retrospective Studies
Sensitivity analysis
Stroke Volume
Variables
Ventricular Dysfunction, Left - complications
Ventricular Function, Left
ACS
Long-term mortality
Mildly reduced ejection fraction
Left ventricular ejection fraction
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Summary:Aims Left ventricular ejection fraction (LVEF) ≤ 40% is a well‐established risk factor for mortality after acute coronary syndromes (ACS). However, the long‐term prognostic impact of mildly reduced ejection fraction (EF) (LVEF 41–49%) after ACS remains less clear. Methods and results This was a retrospective study enrolling patients admitted with ACS included in a single‐centre databank. LVEF was assessed by echocardiography during index hospitalization. Patients were divided in the following categories according to LVEF: normal (LVEF ≥ 50%), mildly reduced (LVEF 41–49%), and reduced (LVEF ≤ 40%). The endpoint of interest was all‐cause death after hospital discharge. A multivariable Cox model was used to adjust for confounders. A total of 3200 patients were included (1952 with normal EF, 375 with mildly reduced EF, and 873 with reduced EF). The estimated cumulative incidence rates of mortality at 10 years for patients with normal, mildly reduced, and reduced EF were 24.8%, 33.5%, and 41.3%, respectively. After adjustments, the presence of reduced EF was associated with higher mortality compared with normal EF [adjusted hazard ratio (HR) 1.64; 95% confidence interval (CI) 1.36–1.96; P < 0.001], as was mildly reduced EF compared with normal EF (adjusted HR 1.33; 95% CI 1.05–1.68; P = 0.019). The presence of reduced EF was not associated with a statistically significantly higher mortality compared with mildly reduced EF (adjusted HR 1.23; 95% CI 0.96–1.57; P = 0.095). Conclusions In patients with ACS, mildly reduced EF measured in the acute phase was associated with higher long‐term mortality compared with patients with normal EF. These data emphasize the importance of anti‐remodelling therapies for ACS patients who have LVEF in the mildly reduced range.
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ISSN:2055-5822
2055-5822
DOI:10.1002/ehf2.14201