Prognostic factors affecting the all-cause death and sudden cardiac death rates of post myocardial infarction patients with low left ventricular ejection fraction.
BACKGROUND
Post myocardial infarction (post-MI) patients with low left ventricular ejection fraction (LVEF) have been candidates for an implantable cardioverter-defibrillator (ICD) since the Multicenter Automatic Defibrillator Implantation Trail II (MADIT II). However, due to the high costs of ICDs, widespread usage has not been accepted. Therefore, further risk stratification for post-MI patients with low LVEF may aid in the selection of patients that will benefit most from ICD treatment.


METHODS
Four hundred and seventeen post-MI patients with low LVEF (< or = 35%) were enrolled in the study. All the patients received standard examination and proper treatment and were followed up to observe the all-cause death rate and sudden cardiac death (SCD) rate. Then COX proportional-hazards regression model was used to investigate the clinical factors which affect the all-cause death rate and SCD rate.


RESULTS
Of 55 patients who died during (32 +/- 24) months of follow-up, 37 (67%) died suddenly. After adjusting for baseline clinical characteristics, multivariate COX proportional-hazards regression model identified the following variables associated with death from all causes: New York Heart Association (NYHA) heart failure class > or = III (Hazard ratio: 2.361), LVEF < or = 20% (Hazard ratio: 2.514), sustained ventricular tachycardia (Hazard ratio: 6.453), and age > or = 70 years (Hazard ratio: 3.116). The presence of sustained ventricular tachycardia (Hazard ratio: 6.491) and age > or = 70 years (Hazard ratio: 2.694) were specifically associated with SCD.


CONCLUSIONS
In the post-MI patients with low LVEF, factors as LVEF < or = 20%, age > or = 70 years, presence of ventricular tachycardia, and NYHA heart failure class > or = III predict an adverse outcome. The presence of sustained ventricular tachycardia and age > or = 70 years was associated with occurrence of SCD in these patients.
Dai
Shi-Mo
SM
Center for Arrhythmia Diagnosis and Treatment, Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China.
Zhang
Shu
S
Chen
Ke-Ping
KP
Hua
Wei
W
Wang
Fang-Zheng
FZ
Chen
Xin
X
D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use; D000800:Angioplasty, Balloon; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D002423:Cause of Death; D001026:Coronary Artery Bypass; D016757:Death, Sudden, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D016016:Proportional Hazards Models; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000401:mortality / Q000601:surgery / Q000628:therapy
D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents; D000638:Amiodarone