TY - JOUR
T1 - Comparison of three-year outcomes after primary percutaneous coronary intervention in patients with left ventricular ejection fraction <40% versus ≥40% (from the HORIZONS-AMI Trial)
AU - Daneault, Benoit
AU - Généreux, Philippe
AU - Kirtane, Ajay J.
AU - Witzenbichler, Bernhard
AU - Guagliumi, Giulio
AU - Paradis, Jean Michel
AU - Fahy, Martin P.
AU - Mehran, Roxana
AU - Stone, Gregg W.
N1 - Funding Information:
Dr. Witzenbichler has received lecture fees from The Medicines Company, Parsippany, New Jersey; and Boston Scientific Corporation, Natick, Massachusetts. Dr. Guagliumi is a consultant to Boston Scientific Corporation; Volcano Corporation, Rancho Cordova, California; St. Jude Medical, St. Paul, Minnesota; and Cordis Corporation, Miami Lakes, Florida. Dr. Guagliumi has received research grants from Abbott Vascular , Santa Clara, California; Medtronic, Inc. , Minneapolis, Minnesota; Boston Scientific Corporation ; and LightLab Imaging , Westford, Massachusetts. Dr. Mehran has received research grants from Sanofi Aventis , Paris, France, and honoraria from The Medicines Company; Abbott Vascular; Sanofi Aventis; Bristol-Myers Squibb, New Brunswick, New Jersey; Cordis Corporation ; and Astra Zeneca, Wilmington, Delaware. Dr. Stone is a consultant to Boston Scientific Corporation, The Medicines Company, Abbott Vascular, and Medtronic, Inc.
PY - 2013/1/1
Y1 - 2013/1/1
N2 - Left ventricular (LV) dysfunction and multivessel disease (MVD) have been associated with greater mortality after ST-segment elevation myocardial infarction. The aim of this study was to evaluate the impact of LV dysfunction and MVD in patients with ST-segment elevation myocardial infarctions treated with primary percutaneous coronary intervention (PCI). Patients from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial treated with primary PCI in whom baseline LV function was assessed using left ventriculography were included in this study. Early and late (3-year) outcomes were examined in groups of patients with reduced (<40%) and preserved (≥40%) LV ejection fractions (LVEFs), further stratified by the presence of MVD. A total of 2,430 patients were included. Patients with reduced LVEFs were older; were more likely to be women; were more likely to have histories of myocardial infarction, PCI, and heart failure; and were more likely to present in heart failure. Patients with reduced LVEFs had greater 30-day (8.9% vs 0.9%, hazard ratio 9.81, 95% confidence interval 5.23 to 18.42, p <0.0001) and 3-year (17.1% vs 3.7%, hazard ratio 5.03, 95% confidence interval 3.37 to 7.50, p <0.0001) mortality. Among patients with LVEFs <30% (n = 45), 30% to 40% (n = 157), 40% to 50% (n = 373), 50% to 60% (n = 659), and ≥60% (n = 1,196), 3-year mortality was 29.4%, 13.5%, 6.4%, 3.8%, and 2.9%, respectively (p for trend <0.0001). MVD was associated with greater mortality in patients with preserved but not reduced LVEFs. By multivariate analysis, LV dysfunction was the strongest predictor of 30-day and 3-year mortality. In conclusion, the presence of LV dysfunction as assessed on baseline left ventriculography in patients who undergo primary PCI in the contemporary era is a powerful predictor of early and late mortality, regardless of the extent of coronary artery disease.
AB - Left ventricular (LV) dysfunction and multivessel disease (MVD) have been associated with greater mortality after ST-segment elevation myocardial infarction. The aim of this study was to evaluate the impact of LV dysfunction and MVD in patients with ST-segment elevation myocardial infarctions treated with primary percutaneous coronary intervention (PCI). Patients from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial treated with primary PCI in whom baseline LV function was assessed using left ventriculography were included in this study. Early and late (3-year) outcomes were examined in groups of patients with reduced (<40%) and preserved (≥40%) LV ejection fractions (LVEFs), further stratified by the presence of MVD. A total of 2,430 patients were included. Patients with reduced LVEFs were older; were more likely to be women; were more likely to have histories of myocardial infarction, PCI, and heart failure; and were more likely to present in heart failure. Patients with reduced LVEFs had greater 30-day (8.9% vs 0.9%, hazard ratio 9.81, 95% confidence interval 5.23 to 18.42, p <0.0001) and 3-year (17.1% vs 3.7%, hazard ratio 5.03, 95% confidence interval 3.37 to 7.50, p <0.0001) mortality. Among patients with LVEFs <30% (n = 45), 30% to 40% (n = 157), 40% to 50% (n = 373), 50% to 60% (n = 659), and ≥60% (n = 1,196), 3-year mortality was 29.4%, 13.5%, 6.4%, 3.8%, and 2.9%, respectively (p for trend <0.0001). MVD was associated with greater mortality in patients with preserved but not reduced LVEFs. By multivariate analysis, LV dysfunction was the strongest predictor of 30-day and 3-year mortality. In conclusion, the presence of LV dysfunction as assessed on baseline left ventriculography in patients who undergo primary PCI in the contemporary era is a powerful predictor of early and late mortality, regardless of the extent of coronary artery disease.
UR - https://www.scopus.com/pages/publications/84871017796
U2 - 10.1016/j.amjcard.2012.08.040
DO - 10.1016/j.amjcard.2012.08.040
M3 - Article
C2 - 23040595
AN - SCOPUS:84871017796
SN - 0002-9149
VL - 111
SP - 12
EP - 20
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 1
ER -