PMID- 28248882
OWN - NLM
STAT- MEDLINE
DCOM- 20170324
LR  - 20210109
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Print)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 9
DP  - 2017 Mar
TI  - Prognostic value of ejection fraction in patients admitted with acute coronary 
      syndrome: A real world study.
PG  - e6226
LID - 10.1097/MD.0000000000006226 [doi]
LID - e6226
AB  - There are limited data regarding factors affecting outcomes among acute coronary 
      syndrome (ACS) patients presenting with varying degrees of left ventricle (LV) 
      dysfunction. We aimed to identify factors associated with mortality according to 
      LV ejection fraction (LVEF) at 1st admission in ACS patients.A total of 8983 ACS 
      patients prospectively enrolled in the Acute Coronary Syndrome Israeli Survey 
      (2000-2010) were categorized according to their LVEF at admission: severe LV 
      dysfunction (LVEF < 30% [n = 845]), mild-moderate LV dysfunction (LVEF 30%-49% 
      [n = 4470]); preserved LV function (LVEF >/= 50% [n = 3659]). Multivariable Cox 
      proportional hazards regression modeling was used to assess the risk factors for 
      1-year mortality according to LVEF on admission.Over the past decade there was a 
      gradual decline in the proportion of patients admitted with low LVEF. Mortality 
      rates were highest among patients with severe LV dysfunction (36%), intermediate 
      among those with mild-moderate LV dysfunction (10%), and lowest among those with 
      preserved LV function (4%, P < 0.001). We recognized different risk factors for 
      mortality according to LVEF at admission. Admission clinical features (syncope, 
      anterior myocardial infarction, and ST elevation myocardial infarction [STEMI]) 
      predicted mortality risk in patients with severe LV dysfunction (all P < 0.05), 
      whereas the presence of comorbidities (hypertension, diabetes mellitus, chronic 
      renal failure, and peripheral arterial disease) predicted mortality risk in 
      patients with more preserved LV function. Age and admission Killip class >/=II were 
      consistent predictors in all LVEF subsets.LVEF at admission is a strong predictor 
      of mortality in ACS, and prognostic factors differ according to LVEF during 
      admission. In patients with severe LV dysfunction signs of clinical instability 
      are related to 1-year mortality; in patients with a more preserved LV function 
      the prognosis is related to the presence of co-morbidities.
FAU - Perelshtein Brezinov, Olga
AU  - Perelshtein Brezinov O
AD  - Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan Sackler School of 
      Medicine, Tel-Aviv University, Tel Aviv, Israel.
FAU - Klempfner, Robert
AU  - Klempfner R
FAU - Zekry, Sagit Ben
AU  - Zekry SB
FAU - Goldenberg, Ilan
AU  - Goldenberg I
FAU - Kuperstein, Rafael
AU  - Kuperstein R
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - IM
MH  - Acute Coronary Syndrome/*diagnosis/mortality
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Humans
MH  - Israel/epidemiology
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - Prospective Studies
MH  - *Stroke Volume
PMC - PMC5340455
COIS- The authors have no funding and conflicts of interest to disclose.
EDAT- 2017/03/02 06:00
MHDA- 2017/03/25 06:00
PMCR- 2017/03/03
CRDT- 2017/03/02 06:00
PHST- 2017/03/02 06:00 [entrez]
PHST- 2017/03/02 06:00 [pubmed]
PHST- 2017/03/25 06:00 [medline]
PHST- 2017/03/03 00:00 [pmc-release]
AID - 00005792-201703030-00033 [pii]
AID - MD-D-16-01817 [pii]
AID - 10.1097/MD.0000000000006226 [doi]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Mar;96(9):e6226. doi: 10.1097/MD.0000000000006226.