Can an elderly woman's heart be too strong?: Increased mortality with high versus normal ejection fraction after an acute coronary syndrome. The Global Registry of Acute Coronary Events

• Published in: The American heart journal Vol. 160; no. 5; pp. 849 - 854
• Main Authors: SAAB, Fadi A, STEG, Philippe Gabriel, AVEZUM, Alvaro, LOPEZ-SENDON, José, ANDERSON, Frederick A, WEI HUANG, EAGLE, Kim A
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby 01-11-2010; Elsevier Limited
• Subjects: Acute Coronary Syndrome - mortality; Acute Coronary Syndrome - physiopathology; Age Factors; Aged; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular system; Coronary heart disease; Coronary vessels; Female; Follow-Up Studies; Global Health; Heart; Heart attacks; Hospital Mortality - trends; Humans; Investigative techniques of hemodynamics; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Mortality; Myocarditis. Cardiomyopathies; Prognosis; Registries; Retrospective Studies; Risk Factors; Severity of Illness Index; Stroke Volume - physiology; Survival Rate - trends; Time Factors; Ventricular Function, Left - physiology; Women; Human; Heart; High; Prognosis; Acute; Mortality; Coronary artery; Cardiovascular disease; Normal; Myocardial disease; Coronary heart disease; Strong; Female; Circulatory system; Hemodynamics; Cardiology; Woman; Acute coronary syndrome; Elderly; Comparative study; Ejection fraction
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2010.07.018

Coronary artery disease is the leading cause of death in women. We sought to validate previous clinical experience in which we have observed that elderly women with a very high left ventricular ejection fraction (LVEF) are at increased risk of death compared with elderly women with acute coronary syndromes with a normal LVEF.
Data from 5,127 elderly female patients (age >65 years) enrolled in the Global Registry of Acute Coronary Events were collected. Patients were divided into 3 groups based on their LVEF: group I had a low ejection fraction (<55%), group II had a normal ejection fraction (55%-65%), and group III had a high ejection fraction (>65%). χ² test and multiple logistic regression analysis were performed. The main outcome measures were death in-hospital and death, stroke, rehospitalization, and myocardial infarction at 6-month follow-up.
Hospital mortality was 12% in group I. Patients in group III were more likely to die in-hospital than those in group II (P = .003). Multivariable logistic regression showed that high ejection fraction was an independent predictor of hospital death (odds ratio [OR] 2.5, 95% CI [CI] 1.2-5.2, P = .01), 6-month death (OR 2.0, 95% CI 1.1-3.4, P = .01), and cardiac arrest/ventricular fibrillation (OR 2.5, 95% CI 1.2-5.0, P = .01) compared with the normal ejection fraction group.
Having a very high LVEF (> 65%) is associated with worse survival and higher rates of sudden cardiac death than an LVEF considered to be in the reference range.