RELATIONSHIP BETWEEN SERIAL MEASUREMENTS OF LV EJECTION FRACTION AND CARDIOVASCULAR EVENTS IN PATIENTS WITH ACUTE CORONARY SYNDROME

초록

Background:Serial change of LV ejection fraction (LVEF) and its clinical impact have not been demonstrated in large-sized patients with acute coronary syndrome (ACS). Methods:Serial LVEFs were measured in 2,872 ACS cohort. Patients were stratified into 4 groups according to LVEF (on-admission & 1-month post-PCI): (1) decreased (LVEF < 55%)-decreased group (26.6%); (2) preserved-decreased group (5.2%); (3) decreased-preserved group (17.5%); and (4) preserved-preserved group (50.7%). Clinical events were defined as all-cause death and MACE (a composite of CV death, non-fatal MI, and ischemic stroke).Results:With a median follow-up of 33.0 (IQR: 16.6, 53.2) months, the rates of all-cause death significantly differed across the groups (log-rank test, p <0.001, Figure), in which the decreased-decreased group showed the greatest risk of all-cause death compared with other groups. After adjustment, the decreased-decreased group was the strongest independent predictor in terms with all-cause death (HR 3.14, 95% CI 2.03-4.86, p <0.001) and MACE (HR 1.57, 95% CI 1.14-2.17, p =0.006) occurrence. In multivariate analysis, on-admission LVEF ≤ 48% (OR 6.51, 95% CI 5.01-8.46, p<0.001) was associated with maintenance of persistent LV dysfunction.Conclusion:This is the first study to show that re-evaluation of LVEF 1 month after PCI can help to stratify the risks of all-cause death and adverse CV event in ACS patients. In addition, decreased LVEFon-admission showed poor recovery from LV dysfunction.