title: End-systolic volume index at 90 to 180 minutes into reperfusion therapy for acute myocardial infarction is a strong predictor of early and late mortality. The Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO)-I Angiographic Investigators.
abstract: BACKGROUND
  Left ventricular remodeling is an important sequela of myocardial infarction (MI). Although remodeling occurs soon after MI, the effect of early left ventricular dilatation on outcome is not established and may be useful for early risk stratification. We assessed whether end-systolic volume index (ESVI) at 90 to 180 minutes into thrombolytic therapy for MI is associated with adverse outcomes.
  
  
  RESULTS
  In the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO)-I study, 41021 patients with evolving MI received one of four thrombolytic regimens. At 90 or 180 minutes into reperfusion therapy, 1300 patients underwent left ventriculography. ESVI was measured and correlated with adverse outcomes: 30-day and 1-year mortality and in-hospital congestive heart failure, shock, and reinfarction. Clinical variables were also tested in a stepwise logistic regression analysis to determine predictors of left ventricular dilatation. ESVI was directly related to all adverse outcomes with univariate analysis. ESVI of > or = 40 mL/m2 was independently associated with mortality (adjusted odds ratio [95% confidence interval]: 30-day, 3.4 [2.0 to 5.9]; 1-year, 4:1 [2.6 to 6.2], both P < .001). Male sex, prior angina or MI, weight of < 70 kg, heart rate of > or = 80 bpm, systolic blood pressure of < 110 mm.Hg, and anterior infarction were independent predictors of an ESVI of > or = 40 mL/m2.
  
  
  CONCLUSIONS
  Left ventricular ESVI early into reperfusion therapy for MI strongly predicts adverse outcomes, including early and late mortality. The study establishes the role of very early left ventricular dilatation on outcome in MI and may be useful in identifying high-risk patients who might benefit from aggressive treatment, including the early use of ACE inhibitors.
authors.affiliation: Cleveland Clinic Foundation, OH 44195-0001, USA.
authors.forename: R Q
authors.initials: RQ
authors.lastname: Migrino
authors.forename: J B
authors.initials: JB
authors.lastname: Young
authors.forename: S G
authors.initials: SG
authors.lastname: Ellis
authors.forename: H D
authors.initials: HD
authors.lastname: White
authors.forename: C F
authors.initials: CF
authors.lastname: Lundergan
authors.forename: D P
authors.initials: DP
authors.lastname: Miller
authors.forename: C B
authors.initials: CB
authors.lastname: Granger
authors.forename: A M
authors.initials: AM
authors.lastname: Ross
authors.forename: R M
authors.initials: RM
authors.lastname: Califf
authors.forename: E J
authors.initials: EJ
authors.lastname: Topol
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000009:adverse effects / Q000401:mortality*; D016017:Odds Ratio; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate; D015912:Thrombolytic Therapy
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors