J Lipid Atheroscler.  2016 Jun;5(1):37-47. 10.12997/jla.2016.5.1.37.

Long-term Clinical Outcomes in Acute Myocardial Infarction Patients with Left Ventricular Dysfunction

• Jeong J
• Jeong MH
• Hong YJ
• Kim JH
• Ahn Y
• Cho JG
• Park JC

• KMID: 2328837
• DOI: http://doi.org/10.12997/jla.2016.5.1.37

Abstract

OBJECTIVE
The purpose of this study was to define the effect of the changes of left ventricular ejection fraction (LVEF) on long-term major adverse cardiac events (MACEs) in patients with acute myocardial infarction (AMI).
METHODS
Clinical analysis was performed on 1,188 AMI patients who completed follow- up 2-dimensional (2D) echocardiography after one year and clinical follow-up for 5 years. These patients were divided into three groups according to the LVEF change ratio: group A [increased LVEF change ratio, N=626], group B [decreased LVEF change ratio<20%, N=414], group C [decreased LVEF change ratio≥20%, N=148].
RESULTS
Initial low LVEF group and normal LVEF group showed no differences in MACEs. The mean initial and follow-up LVEF were 54.4±12.2% and 60.4±12.3% in the group A, 54.6±13.0% and 47.9±12.1% in the group B, and 56.5±12.6% and 39.9±11.6% in the group C (p=0.71). Total MACEs occurred in 62 (9.9%) patients in the group A, 83 (20.0%) patients in the group B, 44 (29.7%) patients in the group C during 5-year clinical follow-up (p=0.01). Initial low EF (<45%) was not a risk factor for long-term MACEs (Odd ratio (OR), 1.686; 95% confidence index (CI), 0.861-2.862, p=0.065), but the LVEF change ratio was a strong risk factor for long-term MACEs (OR, 3.731; 95% CI, 2.039-6.828, p=0.001). MACE-free survivals of patients with initial low LVEF and patients with low LVEF during follow-up period showed no significant differences (p=0.731).
CONCLUSION
Initial low LVEF is not a predictor of long-term MACEs, but the decreased LVEF ratio during follow-up period is a strong predictor of long-term MACEs.

Keyword

Myocardial Infarction; Heart Failure; Prognosis; Left Ventricular Ejection Fraction; Major Adverse Cardiac Events

MeSH Terms

Echocardiography
Follow-Up Studies
Heart Failure
Humans
Myocardial Infarction*
Prognosis
Risk Factors
Stroke Volume
Ventricular Dysfunction, Left*

Figure

• 

  Fig. 1 Major adverse cardiac event (MACE)-free survivals according to left ventricular ejection fraction (LVEF). (A) MACE-free survivals according to initial LVEF. Group I: initial LVEF <45%, Group II: initial LVEF ≥45%, (B) MACE-free survivals according to LVEF change. Group A: increased LVEF at follow-up compared with initial LVEF, Group B: decreased LVEF change ratio <20% at follow-up, Group C: patients with decreased LVEF change ratio ≥20% at follow-up.

• 

  Fig. 2 Comparison of long-term MACEs between initial low LVEF and low LVEF at follow-up.

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