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ȣ - 550941 220 |
| Predictors of early and long-term mortality in AMI patients with reduced left ventricular systolic function from Korean AMI (KOMIR) registry |
| 연세대 원주의대 심장내과¹, 영남의대 심장내과² , 성균관의대 심장내과³, 가천의대 심장내과⁴, 전남의대 순환기내과 5 |
| 유병수 ¹ , 이준원¹, 윤영진¹, 안성균¹, 이승환¹,윤정한¹, 김영조², 권현철³, 안태훈⁴, 정명호 5 |
Background and objectives: Despite significant advances in its treatment, acute myocardial infarction (AMI) remains an important cause of heart failure (HF). However, little evidence has been obtained with respect to the impact of left ventricular systolic dysfunction (LVSD) in AMI, especially in the percutaneous coronary intervention (PCI) and high performance era of echocardiography. Our aim was to study the pattern of early and late mortality of LVSD and impact on LVSD during AMI.
Methods: Of total 16,264 acute myocardial infarction patients enrolled in KORMI (Korean Registry of AMI), 1002 patients were included according to the echocardiography (EF<45%) with complete medical record for echocardiography and significant biomarker. A logistic model developed to identify significant predictors of early (in-hospital and within 30 day) and long-term (at 12 month) adverse events including death, re-MI and TVR.
Results; Mean age was 67.2±12.4 years, 50.5% were women, and 38.1% had diabetes. Mean left ventricular ejection fraction was 36.3±6.9%. Early period adverse event occurred in 4.7%. and long-term event at 12 month after discharge occurred in 11.6% Potential predictor variables were used in a logistic regression model. In comparing to patients with preserved LV EF, frequency of adverse event was significantly lower (p<0.05). Multivariable predictors of early AE included increased age [Odds ratio (OR) 1.033, 95% confidence interval (CI) 1.014-1.053], low EF (OR 0.950, 95% CI 0.925-0.975) and maximal CK-MB per 10 unit increase (OR 1.155, 95% CI 1.030-1.295) and high Cr (OR 1.563, 95% CI 1.092-2.36) and NT-proBNP per 10 mg/dl increase (OR 1.333, 95% CI 1.143-1.554). Multivariable predictors of late AE included increased age [Odds ratio (OR) 1.029, 95% confidence interval (CI) 1.011-1.047], low EF (OR 0.957, 95% CI 0.932-0.982) and NT-proBNP per 10mmHg increase OR (1.379, 95% CI 1.196-1.590).
Conclusion: Despite of high performance of treatment of AMI with LVSD, early and long-term AE for AMI patients with LVSD remains high. These results might help identify patients at high risk for in-hospital mortality who might benefit from aggressive monitoring and intervention.
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