title: Effect of age on the prognostic value of left ventricular function in patients with acute coronary syndrome: A prospective registry study.
abstract: OBJECTIVE
  This study aims to study the prognostic impact of left ventricular function on mortality and examine the effect of age on the prognostic value of left ventricular function.
  
  
  METHODS
  We examined the myocardial ischaemia national audit project registry (2006-2010) data with a mean follow-up of 2.1 years. Left ventricular function was categorised into good (ejection fraction ⩾50%), moderate (ejection fraction 30-49%) and poor (ejection fraction <30%) categories. Cox proportional hazards models were constructed to examine the prognostic significance of left ventricular function in different age groups (<65, 65-74, 75-84 and ⩾85 years) on all-cause mortality adjusting for baseline variables.
  
  
  RESULTS
  Out of 424,848 patients, left ventricular function data were available for 123,609. Multiple imputations were used to impute missing values of left ventricular function and the final sample for analyses was drawn from 414,305. After controlling for confounders, 339,887 participants were included in the regression models. For any age group, mortality was higher with a worsening degree of left ventricular impairment. Increased age reduced the adverse prognosis associated with reduced left ventricular function (hazard ratios of death comparing poor left ventricular function to good left ventricular function were 2.11, 95% confidence interval 1.88-2.37 for age <65 years and 1.28, 95% confidence interval 1.20-1.36 for age ⩾85 years). Older patients had a high mortality risk even in those with good left ventricular function. Hazard ratios of mortality for ⩾85 compared to <65 years (hazard ratio = 1.00) within good, moderate and poor ejection fraction groups were 5.89, 4.86 and 3.43, respectively.
  
  
  CONCLUSIONS
  In patients with acute coronary syndrome, clinicians should interpret the prognostic value of left ventricular function taking into account the patient's age.
authors.affiliation: 1 Cardiovascular Research Group, Keele University, UK.|2 Aberdeen Gerontological and Epidemiological Interdisciplinary Research Group (AGEING), University of Aberdeen, UK.
authors.forename: Chun Shing
authors.initials: CS
authors.lastname: Kwok
authors.affiliation: 3 Norwich Medical School, University of East Anglia, UK.
authors.forename: Max O
authors.initials: MO
authors.lastname: Bachmann
authors.affiliation: 1 Cardiovascular Research Group, Keele University, UK.
authors.forename: Mamas A
authors.initials: MA
authors.lastname: Mamas
authors.affiliation: 3 Norwich Medical School, University of East Anglia, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Stirling
authors.affiliation: 3 Norwich Medical School, University of East Anglia, UK.
authors.forename: Lee
authors.initials: L
authors.lastname: Shepstone
authors.affiliation: 2 Aberdeen Gerontological and Epidemiological Interdisciplinary Research Group (AGEING), University of Aberdeen, UK.
authors.forename: Phyo Kyaw
authors.initials: PK
authors.lastname: Myint
authors.affiliation: 3 Norwich Medical School, University of East Anglia, UK.|4 Department of Medicine, James Paget University Hospital, UK.
authors.forename: M Justin
authors.initials: MJ
authors.lastname: Zaman
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality* / Q000503:physiopathology; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D016277:Ventricular Function, Left
keywords: Acute coronary syndrome; age; left ventricular function; mortality