title: In-hospital measurement of left ventricular ejection fraction and one-year outcomes in acute coronary syndromes: results from the IMMEDIATE Trial.
abstract: BACKGROUND
  In patients with acute coronary syndrome (ACS), reduced left ventricular ejection fraction (LVEF) is a known marker for increased mortality. However, the relationship between LVEF measured during index ACS hospitalization and mortality and heart failure (HF) within 1 year are less well-defined.
  
  
  METHODS
  We performed a retrospective analysis of 445 participants in the IMMEDIATE Trial who had LVEF measured by left ventriculography or echocardiogram during hospitalization.
  
  
  RESULTS
  Adjusting for age and coronary artery disease (CAD) history, lower LVEF was significantly associated with 1-year mortality or hospitalization for HF. For every 5 % LVEF reduction, the hazard ratio [HR] was 1.26 (95 % CI 1.15, 1.38, P < 0.001). Participants with LVEF < 40 % had higher hazard of 1-year mortality or HF hospitalization than those with LVEF > 40 (HR 3.59; 95 % CI 2.05, 6.27, P < 0.001). The HRs for the association of LVEF with the study outcomes were similar whether measured by left ventriculography or by echocardiography, (respectively, HR 1.32; 95 % CI 1.15, 1.51 and 1.21; 95 % CI 1.106, 1.35, interaction P = 0.32) and whether done within 24 h or not within 24 h (respectively, HR 1.28; 95 % CI 1.10, 1.50 and 1.23; 95 % CI 1.10, 1.38, interaction P = 0.67).
  
  
  CONCLUSIONS
  Among patients with ACS, lower in-hospital LVEF is associated with increased 1-year mortality or hospitalization for HF, regardless of the method or timing of the LVEF assessment. This has prognostic implications for clinical practice and suggests the possibility of using various methods of LVEF determination in clinical research.
authors.affiliation: Clinical and Translational Science Graduate Program, Sackler School of Biomedical Sciences, Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA.|Department of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center Harvard Medical School, Boston, MA, USA.|Riverside Methodist Hospital, Ohio Health Heart and Vascular Physicians, Columbus, OH, USA.
authors.forename: Jayanta T
authors.initials: JT
authors.lastname: Mukherjee
authors.affiliation: Center for Cardiovascular Health Services Research, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, #63, Boston, MA, 02111, USA.|Regis College, Weston, MA, USA.
authors.forename: Joni R
authors.initials: JR
authors.lastname: Beshansky
authors.affiliation: Center for Cardiovascular Health Services Research, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, #63, Boston, MA, 02111, USA.|Department of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center Harvard Medical School, Boston, MA, USA.
authors.forename: Robin
authors.initials: R
authors.lastname: Ruthazer
authors.affiliation: Clinical and Translational Science Graduate Program, Sackler School of Biomedical Sciences, Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA.|College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Hadeel
authors.initials: H
authors.lastname: Alkofide
authors.affiliation: Clinical and Translational Science Graduate Program, Sackler School of Biomedical Sciences, Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA.
authors.forename: Madhab
authors.initials: M
authors.lastname: Ray
authors.affiliation: Center for Cardiovascular Health Services Research, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, #63, Boston, MA, 02111, USA.
authors.forename: David
authors.initials: D
authors.lastname: Kent
authors.affiliation: Department of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center Harvard Medical School, Boston, MA, USA.
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Manning
authors.affiliation: MCRI Center for Translational Genomics, Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA, USA.
authors.forename: Gordon S
authors.initials: GS
authors.lastname: Huggins
authors.affiliation: Center for Cardiovascular Health Services Research, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, #63, Boston, MA, 02111, USA. hselker@tuftsmedicalcenter.org.|Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA. hselker@tuftsmedicalcenter.org.
authors.forename: Harry P
authors.initials: HP
authors.lastname: Selker
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D000368:Aged; D004311:Double-Blind Method; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Acute coronary syndromes; Death; Glucose-insulin-potassium; Hospitalization from heart failure; Left ventricular ejection fraction