Value of ejection fraction in in-hospital evolution of patients with acute myocardial infarction. SAC-FAC Argentine Registry of Acute Myocardial Infarction

Abstract

Objectives: To evaluate left ventricular ejection fraction (LVEF) in hospital evolution of patients with Acute Myocardial Infarction with ST elevation (STEMI). Materials and methods: Prospective, observational and multicenter study, with 2672 patients analyzed and divided into 3 groups: I (LVEF≤30%), II (LVEF 30 to 49%) and III (LVEF≥50%). Results: The mean LVEF was 48.84%±11.7. The events in the 3 groups were hospital mortality:
31.7 vs 5.9 vs 3.1%, (p<0.001) in groups I, II and III, reinfarction 9.6 vs 2.7 vs 1.6%, (p<0.001), heart failure (HF): 58 vs 28.1 vs 8.8%, (p<0.001), cardiac arrest (CA) 43.6 vs 11.4 vs 8%, (p<0.001), atrial fibrillation (AF) 10.8 vs 8 vs 3.9% (p<0.001). They used: Swan Ganz 19.8 vs 5.6 vs 1.4%,
(<0.001), balloon pump 20 vs 3.3 vs 1.1%, (p<0.001), coronary angiography (CAG) 83.3 vs 79.3vs 80% (p=0.58), primary angioplasty (PTCA) 77.2 vs 67 vs 67%, (p=0.27), and myocardial revascularization surgery (MRS) 4 vs 1.5 vs 1.2%, p=0.09; 29.4 vs 22.4 vs 20.4% were diabetics (p=0.045), previous AMI 25 vs 11.8 vs 7.7%, and age 68.4±12 vs 62±11.5 vs 60±12.8 years, (p=0.001). The predictors of in-hospital mortality were age OR 1.041 (95% CI 1.020-1.061, p<0.001), heart rate OR 1.015 (95% CI 1.005-1.024, p=0.004), Killip OR 2.816 (95% CI 1.266-3.499, p<0.0019 and LVEF≤30%
OR 4.539 (95% CI 1.273-5.065, p=0.008). Conclusions: Patients with LVEF≤30% had a greater number of events, required a greater number of invasive strategies, and a similar use of reperfusion strategies. LVEF is a powerful independent predictor of hospital mortality.