Abstract 10724: Long-Term Mortality After Acute Coronary Syndromes Among Patients with Normal, Mid-Range or Low Ejection Fraction

Abstract

Introduction: Left ventricle ejection fraction (LVEF) is a well-established marker for survival after acute coronary syndromes (ACS). While there has been strong association between low ejection fraction (i.e., LVEF < 40%) and mortality, the long-term prognostic impact of mid-range EF (LVEF 40-49%) after ACS remains less clear. Methods: This was a retrospective study enrolling consecutive patients admitted with ACS included in a single tertiary center databank. LVEF was assessed by echocardiography during index hospitalization. Patients were divided in the following categories according to LVEF: normal (LVEF ≥ 50%), mid-range (40-49%) and low (< 40%). The endpoint of interest was all-cause death after hospital discharge. A multivariable Cox regression model was used to adjust for confounders. The model was adjusted for age, sex, race, history of diabetes mellitus, prior HF, arterial hypertension, dyslipidemia, smoking, STEMI versus non-ST elevation ACS, prior MI, prior PCI, prior CABG, creatinine and Killip class at admission Results: A total of 3200 patients were included (1,952 with normal EF; 659 with mid-range EF and 589 with low EF); mean age was 63.5 ± 12.4 years (63.2±12.3, 63.9±12.7 and 64.2±12.4 years, respectively for normal, mid-range and low EF; p = 0.14); 2216 (69.3%) were male and 1257 (39.3%) presented with STEMI. The median follow-up time was 5 years, and the maximum follow-up time was 17.8 years. Overall results are shown in the Figure 1. In a sensitivity analysis using a different definition for mid-range EF (36-54%), results remained similar (data not shown). Conclusion: In ACS patients discharged alive from hospital, mid-range EF measured in the acute phase was associated with increased long-term mortality compared to patients with normal EF. This magnitude of effect was similar to that observed for patients with low EF. These data reinforce the need to consider anti-remodeling therapies also for ACS patients who have LVEF in the mid-range.