Korean Circ J.  2012 Oct;42(10):692-697. 10.4070/kcj.2012.42.10.692.

Predictors of Long-Term Survival in Acute Coronary Syndrome Patients With Left Ventricular Dysfunction After Percutaneous Coronary Intervention

• Lee DH
• Jeong MH
• Rhee JA
• Choi JS
• Lee KH
• Lee MG
• Sim DS
• Park KH
• Yoon NS
• Yoon HJ
• Kim KH
• Park HW
• Hong YJ
• Kim JH
• Ahn Y
• Cho JG
• Park JC
• Kang JC

• KMID: 1826466
• DOI: http://doi.org/10.4070/kcj.2012.42.10.692

Abstract

BACKGROUND AND OBJECTIVES
Predictive factors of mortality in acute coronary syndrome (ACS) patients with left ventricular dysfunction were analyzed during 5-year clinical follow-up after percutaneous coronary intervention (PCI).
SUBJECTS AND METHODS
A total of 329 ACS consecutive patients (64.6+/-11.3 years, 227 males) who underwent PCI from January 2001 to March 2006 were followed for 5 years. All patients had lower than 40% of left ventricular ejection fraction (LVEF). Patients were divided into Group I (survived longer than 5-years: n=130, 101 males) and Group II (survived shorter than 5 years: n=199, 126 males).
RESULTS
The cumulative survival rate was 88.0% at 1 month, 78.0% at 6 months, 75.0% at 1 year, 67.0% at 2 years, 62.0% at 3 years, 57.0% at 4 years and 40% at 5-years. Group II was older (61.6+/-11.2 years vs. 66.4+/-11.4 years, p<0.001), and showed higher prevalence of female gender (28.4% vs. 36.7%, p=0.006) and lower LVEF (35.3+/-5.2 vs. 33.6+/-5.6) than Group I. The independent predictors for mortality were LVEF <30% {odds ratio (OR)=1.793, 95% confidence interval (CI): 1.234-2.452, p=0.002}, serum creatinine >3.0 mg/dL (OR=2.455, 95% CI: 1.306-4.614, p=0.005), older than 65 years (OR=1.594, 95% CI: 1.152-2.206, p=0.005), and female gender (OR=1.524, 95% CI: 1.090-2.130, p=0.014).
CONCLUSION
Five-year survival rate was 40% in ACS patients with left ventricular dysfunction, and the predictors for mortality were low LVEF, high serum creatinine, old age, and female gender.

Keyword

Acute coronary syndrome; Prognosis; Heart failure; Angioplasty

MeSH Terms

Acute Coronary Syndrome
Angioplasty
Creatinine
Female
Follow-Up Studies
Heart Failure
Humans
Percutaneous Coronary Intervention
Prevalence
Prognosis
Stroke Volume
Survival Rate
Ventricular Dysfunction, Left
Creatinine

Figure

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  Fig. 1 Five-year survival in acute coronary syndrome patients with left ventricular dysfunction.

Reference

1. Korea National Statistical Office. 2004 annual report on the course of as death statistics. 2004. Korea National Statistical Office;32–34.

2. Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction). Circulation. 2004. 110:e82–e292.

3. Pfeffer MA, Braunwald E, Moyé LA, et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction: results of the survival and ventricular enlargement trial: the SAVE Investigators. N Engl J Med. 1992. 327:669–677.

4. Schühlen H, Kastrati A, Dirschinger J, et al. Intracoronary stenting and risk for major adverse cardiac events during the first month. Circulation. 1998. 98:104–111.

5. Kohli RS, DiSciascio G, Cowley MJ, Nath A, Goudreau E, Vetrovec GW. Coronary angioplasty in patients with severe left ventricular dysfunction. J Am Coll Cardiol. 1990. 16:807–811.

6. Halkin A, Singh M, Nikolsky E, et al. Prediction of mortality after primary percutaneous coronary intervention for acute myocardial infarction: the CADILLAC risk score. J Am Coll Cardiol. 2005. 45:1397–1405.

7. Holper EM, Blair J, Selzer F, et al. The impact of ejection fraction on outcomes after percutaneous coronary intervention in patients with congestive heart failure: an analysis of the National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry and Dynamic Registry. Am Heart J. 2006. 151:69–75.

8. Quinones MA, Waggoner AD, Reduto LA, et al. A new, simplified and accurate method for determining ejection fraction with two-dimensional echocardiography. Circulation. 1981. 64:744–753.

9. Scanlon PJ, Faxon DP, Audet AM, et al. ACC/AHA guidelines for coronary angiography: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Coronary Angiography): developed in collaboration with the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol. 1999. 33:1756–1824.

10. Gibson CM, Cannon CP, Daley WL, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996. 93:879–888.

11. Gwon HC, Lyu OY, Park SW, et al. Long term survival rate and prognostic factors of acute myocardial infarction. Korean Circ J. 1990. 20:687–696.

12. Zannad F, Briancon S, Juilliere Y, et al. Incidence, clinical and etiologic features, and outcomes of advanced chronic heart failure: the EPICAL Study: Epidémiologie de l'Insuffisance Cardiaque Avancée en Lorraine. J Am Coll Cardiol. 1999. 33:734–742.

13. Halkin A, Stone GW, Dixon SR, et al. Impact and determinants of left ventricular function in patients undergoing primary percutaneous coronary intervention in acute myocardial infarction. Am J Cardiol. 2005. 96:325–331.

14. Kouvaras G, Cokkinos D, Spyropoulou M. Increased mortality of diabetics after acute myocardial infarction attributed to diffusely impaired left ventricular performance as assessed by echocardiography. Jpn Heart J. 1988. 29:1–9.

15. Krumholz HM, Howes CJ, Murillo JE, Vaccarino LV, Radford MJ, Ellerbeck EF. Validation of a clinical prediction rule for left ventricular ejection fraction after myocardial infarction in patients > or = 65 years old. Am J Cardiol. 1997. 80:11–15.

16. Walsh CR, O'Donnell CJ, Camargo CA Jr, Giugliano RP, Lloyd-Jones DM. Elevated serum creatinine is associated with 1-year mortality after acute myocardial infarction. Am Heart J. 2002. 144:1003–1011.

17. Kim JY, Jeong MH, Ahn YK, et al. Decreased glomerular filtration rate is an independent predictor of in-hospital mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Korean Circ J. 2011. 41:184–190.

18. Tofler GH, Stone PH, Muller JE, et al. Effects of gender and race on prognosis after myocardial infarction: adverse prognosis for women, particularly black women. J Am Coll Cardiol. 1987. 9:473–482.

19. Choi DJ, Han S, Jeon ES, et al. Characteristics, outcomes and predictors of long-term mortality for patients hospitalized for acute heart failure: a report from the Korean Heart Failure Registry. Korean Circ J. 2011. 41:363–371.

20. Demirovic J, Blackburn H, McGovern PG, Luepker R, Sprafka JM, Gilbertson D. Sex differences in early mortality after acute myocardial infarction (the Minnesota Heart Survey). Am J Cardiol. 1995. 75:1096–1101.

21. He J, Klag MJ, Whelton PK, Zhoa Y, Weng X. Short- and long-term prognosis after acute myocardial infarction in Chinese men and women. Am J Epidemiol. 1994. 139:693–703.

22. Maynard C, Litwin PE, Martin JS, Weaver WD. Gender differences in the treatment and outcome of acute myocardial infarction: Results from the Myocardial Infarction Triage and Intervention Registry. Arch Intern Med. 1992. 152:972–976.

23. Karlson BW, Herlitz J, Hartford M. Prognosis in myocardial infarction in relation to gender. Am Heart J. 1994. 128:477–483.

24. Fiebach NH, Viscoli CM, Horwitz RI. Differences between women and men in survival after myocardial infarction: biology or methodology? JAMA. 1990. 263:1092–1096.