title: The relationships of left ventricular ejection fraction, end-systolic volume index and infarct size to six-month mortality after hospital discharge following myocardial infarction treated by thrombolysis.
abstract: OBJECTIVE
  We sought to relate left ventricular ejection fraction (EF), end-systolic volume index (ESVI) and infarct size (IS), as measured in a single randomized trial, to six-month mortality after myocardial infarction (MI) treated with thrombolysis.
  
  
  BACKGROUND
  These three prognostic indicators have never been compared in the same study group.
  
  
  METHODS
  Radionuclide angiographic and single-photon emission computed tomographic sestamibi measurements of IS were performed in 1,194 and 1,181 patients, respectively, of the 2,948 patients enrolled in the Collaborative Organization for RheothRx Evaluation (CORE) trial. Ejection fraction, ESVI and IS, as measured by central laboratories in these radionuclide substudies, were tested for their association with six-month mortality.
  
  
  RESULTS
  Ejection fraction (n = 1,137; p < 0.0001), ESVI (n = 945; p = 0.055) and IS (n = 1,164; p = 0.03) were all associated with six-month mortality. Each of these measurements was significantly correlated with the other two, regardless of MI location. In an "overlap" group of 753 patients (25.5% of the population; 13 deaths) in whom all three measurements were available, EF (p = 0.001) was a stronger predictor than ESVI (p = 0.005) or IS (p = 0.01). Neither of the other two measurements added independent prognostic information. The highest risk subgroup (EF < 30%) had an 11% six-month mortality, but comprised only 95 patients (8.3%).
  
  
  CONCLUSIONS
  Ejection fraction, ESVI and IS measurements performed one to two weeks after MI can each predict six-month mortality. Ejection fraction was superior to the other two measurements. However, this study had limited power to detect independent significance of ESVI or IS.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA. gibbons.raymond@mayo.edu
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Burns
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Gibbons
authors.forename: Qilong
authors.initials: Q
authors.lastname: Yi
authors.forename: Robin S
authors.initials: RS
authors.lastname: Roberts
authors.forename: Todd D
authors.initials: TD
authors.lastname: Miller
authors.forename: Gary L
authors.initials: GL
authors.lastname: Schaer
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Anderson
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
mesh_terms: D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality*; D011379:Prognosis; D011875:Radionuclide Angiography; D013318:Stroke Volume; D016019:Survival Analysis; D015912:Thrombolytic Therapy; D015899:Tomography, Emission-Computed, Single-Photon; D016277:Ventricular Function, Left