Predictive power of systolic function and congestive heart failure in patients with patients admitted for chest pain without ST elevation in the troponin era.
BACKGROUND
Impaired systolic function and congestive heart failure (CHF) are powerful predictors of adverse outcomes in patients with myocardial infarction (MI). However, there are little data in which both of these variables were assessed in heterogenous patients admitted from the emergency department for exclusion of ischemia.


METHODS
Consecutive patients admitted for MI exclusion who had ejection fraction (EF) measured were included. Systolic dysfunction was defined as EF <40%. Congestive heart failure was diagnosed based on clinical or x-ray evidence in the first 24 hours. Multivariate analysis was used to determine predictors of 30-day and 1-year mortality.


RESULTS
Of the 4,343 consecutive patients admitted, 3,682 (85%) had EF assessed (including 97% of the troponin I [TnI]-positive patients) and were included. One-year unadjusted mortality was 9.5%, but in the presence of systolic dysfunction or CHF, it increased to 22% and 26%, respectively. The most important multivariate predictors of 30-day and 1-year mortality were similar and included CHF (OR for 1-year mortality 2.5, 95% CI 1.9-3.4), TnI elevations (OR 2.0, 95% CI 1.5-2.6), and severe renal failure (OR 5.2, 95% CI 3.7-7.2). Systolic dysfunction was predictive of 1 year (OR 1.9, 95% CI 1.4-2.5) but not 30-day mortality. Results were similar in the 3,018 patients who were troponin-negative.


CONCLUSIONS
Congestive heart failure is an independent predictor of both short- and long-term mortality in patients admitted for MI exclusion. In contrast, systolic dysfunction predicts long-term but not short-term mortality. One cannot be used as a surrogate for the other.
Kontos
Michael C
MC
Cardiology Division, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA. mkontos@mcvh-vcu.edu
Jamal
Sameer
S
Tatum
James L
JL
Ornato
Joseph P
JP
Jesse
Robert L
RL
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000209:etiology; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis*; D011379:Prognosis; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013318:Stroke Volume; D013599:Systole / Q000502:physiology; D019210:Troponin I / Q000097:blood
D015415:Biomarkers; D019210:Troponin I