title: Can an elderly woman's heart be too strong? Increased mortality with high versus normal ejection fraction after an acute coronary syndrome. The Global Registry of Acute Coronary Events.
abstract: BACKGROUND
  Coronary artery disease is the leading cause of death in women. We sought to validate previous clinical experience in which we have observed that elderly women with a very high left ventricular ejection fraction (LVEF) are at increased risk of death compared with elderly women with acute coronary syndromes with a normal LVEF.
  
  
  METHODS
  Data from 5,127 elderly female patients (age >65 years) enrolled in the Global Registry of Acute Coronary Events were collected. Patients were divided into 3 groups based on their LVEF: group I had a low ejection fraction (<55%), group II had a normal ejection fraction (55%-65%), and group III had a high ejection fraction (>65%). χ² test and multiple logistic regression analysis were performed. The main outcome measures were death in-hospital and death, stroke, rehospitalization, and myocardial infarction at 6-month follow-up.
  
  
  RESULTS
  Hospital mortality was 12% in group I. Patients in group III were more likely to die in-hospital than those in group II (P = .003). Multivariable logistic regression showed that high ejection fraction was an independent predictor of hospital death (odds ratio [OR] 2.5, 95% CI [CI] 1.2-5.2, P = .01), 6-month death (OR 2.0, 95% CI 1.1-3.4, P = .01), and cardiac arrest/ventricular fibrillation (OR 2.5, 95% CI 1.2-5.0, P = .01) compared with the normal ejection fraction group.
  
  
  CONCLUSIONS
  Having a very high LVEF (> 65%) is associated with worse survival and higher rates of sudden cardiac death than an LVEF considered to be in the reference range.
authors.affiliation: Department of Internal Medicine, Tufts University School of Medicine-Baystate Medical Center, Springfield, MA, USA. fadisaab17@hotmail.com
authors.forename: Fadi A
authors.initials: FA
authors.lastname: Saab
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: Alvaro
authors.initials: A
authors.lastname: Avezum
authors.forename: José
authors.initials: J
authors.lastname: López-Sendón
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Anderson
authors.forename: Wei
authors.initials: W
authors.lastname: Huang
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality* / Q000503:physiopathology; D000367:Age Factors; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*