title: Different prognostic factors according to left ventricular systolic function in patients with acute myocardial infarction.
abstract: BACKGROUND
  Initial left ventricular (LV) systolic function is a main determinant of clinical outcomes in patients with acute myocardial infarction (AMI). This study was performed to investigate whether AMI patients have different prognostic factors according to their baseline LV systolic function.
  
  
  METHODS
  A total of 12,988 patients with AMI from a nationwide database were analyzed. Major adverse cardiovascular events (MACEs) within 12months of AMI, including death, nonfatal myocardial infarction (MI), and revascularization, were assessed.
  
  
  RESULTS
  Patients were stratified into two groups according to LV ejection fraction (LVEF): those with LVEF<40% and those with LVEF≥40%. Patients with LVEF<40% (n=1962, 15.1%) were older and had more unfavorable cardiovascular risk factors than those with LVEF≥40% (n=11,026, 84.9%). The rate of MACE was higher in patients with LVEF<40% than in those with LVEF≥40% (26.8% vs 11.4%, p<0.001). Independent predictors of 12-month MACEs in patients with LVEF≥40% were history of MI, high Killip stage, three-vessel disease, and lower renal function, which are already known as risk factors. However, diabetes mellitus (hazard ratio [HR], 1.68; 95% confidence interval [CI], 1.17-2.40; p=0.008), and the use of rennin-angiotensin system (RAS) blockers (HR, 0.63; 95% CI, 0.41-0.95; p=0.029) were independent factors for 12-month MACE in patients with LVEF <40%.
  
  
  CONCLUSIONS
  Prognostic factors determining 12-month MACE after AMI are different according to LVEF. Management following AMI should be tailored according to their LV systolic function.
authors.affiliation: Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
authors.forename: Moon-Sun
authors.initials: MS
authors.lastname: Im
authors.affiliation: Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
authors.forename: Hack-Lyoung
authors.initials: HL
authors.lastname: Kim
authors.affiliation: Seoul National University Boramae Medical Center, Seoul, Republic of Korea. Electronic address: shkimmd@snu.ac.kr.
authors.forename: Sang-Hyun
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
authors.forename: Woo-Hyun
authors.initials: WH
authors.lastname: Lim
authors.affiliation: Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Jae-Bin
authors.initials: JB
authors.lastname: Seo
authors.affiliation: Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
authors.forename: Woo-Young
authors.initials: WY
authors.lastname: Chung
authors.affiliation: Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
authors.forename: Joo-Hee
authors.initials: JH
authors.lastname: Zo
authors.affiliation: Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
authors.forename: Myung-A
authors.initials: MA
authors.lastname: Kim
authors.affiliation: Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Kyung-Woo
authors.initials: KW
authors.lastname: Park
authors.affiliation: Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Bon-Kwon
authors.initials: BK
authors.lastname: Koo
authors.affiliation: Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Hyo-Soo
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: In-Ho
authors.initials: IH
authors.lastname: Chae
authors.affiliation: Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Dong-Ju
authors.initials: DJ
authors.lastname: Cho
authors.affiliation: Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Youngkeun
authors.initials: Y
authors.lastname: Ahn
authors.affiliation: Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
mesh_terms: D000368:Aged; D019468:Disease Management; D005260:Female; D006801:Humans; D007677:Kidney Function Tests / Q000379:methods; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D011379:Prognosis; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology
keywords: Acute myocardial infarction; Left ventricular systolic function; Prognosis