2017

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2017/№4

Clinical characteristics and outcomes in patients with acute coronary syndrome and moderately reduced left ventricular ejection fraction (data from RECORD-3 registry)

Erlikh A. D.
N. E. Bauman Municipal Clinical Hospital #29 at the Moscow Department of Health Care, Gospitalnaya Pl. 2, Moscow 111020

Keywords: left ventricular ejection fraction, acute coronary syndrome, register, RECORD, prognosis

DOI: 10.18087/rhj.2017.4.2369

Aim. To evaluate historical data, clinical data, and outcomes in patients with moderately reduced LV EF (mrEF) [40–49%] and to compare them with characteristics of patients with low LV EF (lEF) (<40%) and preserved LV EF (pEF) (≥50%). Results. LV EF was evaluated for 2084 of 2370 included patients (88%); 187 (9%) of these patients had lEF (9%), 439 (21%) – mrEF, and 1458 (70%) – pEF. Proportions of elderly patients (65 or older) were comparable in groups with different LV EF. Among patients with mrEF, proportions of patients with previous MI, ST elevation ACS (STEACS), higher Killip class, blood glucose level at admission >8 mmol/l, creatinine level >100 μmol/l, and high GRACE risk score for in-hospital death were significantly greater. In the group of patients with non-ST elevation ACS (nSTEACS), differences in the frequency of occurrence of angiographically documented coronary stenosis >50 % were revealed. Among patients with pEF coronary stenosis >50% were revealed significantly less than in patients with low and moderately reduced LVEF, but the difference in occurence was not significant between mrEF and pEF groups. Patients with nSTEACS and different LV EFs were not significantly different in incidence of transcutaneous coronary interventions (TCI). Incidence of primary TCI for nSTEACS did not significantly differ for patients with mrEF and pEF but was significantly greater than for patients with lEF. The rate of in-hospital fatal outcomes was the highest for patients with lEF (8.0%), significantly lower for patients with mrEF (3.4%, р=0.023) and the lowest for patients with pEF (1.0%, р=0.001 vs mrEF). Events, which have developed after discharge from the hospital at 12 months of ACS onset were evaluated for 966 included patients. At that time, incidence of fatal outcome was 8.9% and the sum of adverse events (death + MI + stroke + urgent revascularization) was 14.1 %. Proportion of patients who died in one year after discharge from the hospital was the highest among patients with lEF – 22.5%; for patients with mrEF – 11.5% (р=0.043); and the lowest for patients with pEF – 6.6% (0.036 vs mrEF). Proportions of patients with a sum of adverse events at one year after discharge from the hospital did not significantly differ for patients with lEF and mrEF (23.9% and 20.3%, respectively, р=0.65) but was significantly lower for patients with pEF (11.3%, р=0.005). In a multifactorial regression analysis, presence of lEF or mrEF did not become an independent predictor of inhospital death or death in one year after discharge from the hospital. Conclusion. The ACS RECORD-3 registry showed that the presence of LV mrEF was associated with some other risk factors of poor prognosis and higher in-hospital mortality compared to patients with LV pEF. In-hospital mortality was even higher for patients with LV lEF. Incidence of fatal outcomes following discharge from the hospital, at 12 months of ACS also was the highest for patients with LV lEF and the lowest for patients with LV pEF. Neither LV lEF nor LV mrEF was an independent predictor of in-hospital death or death within 12 months of ACS.
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Erlikh A. D. Clinical characteristics and outcomes in patients with acute coronary syndrome and moderately reduced left ventricular ejection fraction (data from RECORD-3 registry). Russian Heart Journal. 2017;16(4):246–252

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