Author + information
- Received April 28, 2017
- Revision received December 22, 2017
- Accepted December 28, 2017
- Published online May 21, 2018.
- Derek S. Chew, MDa,
- Huikuri Heikki, MDb,
- Georg Schmidt, MDc,
- Katherine M. Kavanagh, MDa,
- Michael Dommasch, MDc,
- Poul Erik Bloch Thomsen, MD, DMSCb,
- Daniel Sinnecker, MDc,
- Pekka Raatikainen, MDa and
- Derek V. Exner, MD, MPHa,∗ ()
- aLibin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
- bDepartment of Internal Medicine, Division of Cardiology, University of Oulu, Oulu, Finland
- cMedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- ↵∗Address for correspondence:
Dr. Derek V. Exner, Libin Cardiovascular Institute of Alberta, University of Calgary, GE63 TRW Building, 3280 Hospital Drive NW, Calgary AB T2N 4Z6, Canada.
Objectives This study hypothesizes that a lack of left ventricular ejection fraction (LVEF) recovery after myocardial infarction (MI) would be associated with a poor outcome.
Background A reduced LVEF early after MI identifies patients at risk of adverse outcomes. Whether the change in LVEF in the weeks to months following MI provides additional information on prognosis is less certain.
Methods Change in LVEF between the early (2 to 7 days) and later (2 to 12 weeks) post-MI periods in patients with a first MI was assessed in 3 independent cohorts (REFINE [Risk Estimation Following Infarction Noninvasive Evaluation]; CARISMA [Cardiac Arrhythmia and Risk Stratification after Myocardial Infarction]; ISAR [Improved Stratification of Autonomy Regulation]). Patients were categorized as having no recovery (Δ ≤0%), a modest increase (Δ 1% to 9%), or a large increase (Δ ≥10%) in LVEF. The relationship between change in LVEF and risk of sudden cardiac arrest (SCA) and all-cause mortality were assessed in Cox multivariable models.
Results In REFINE, patients with no LVEF recovery had a higher risk of sudden cardiac arrest (hazard ratio: 5.8; 95% confidence interval: 2.1 to 16.6; p = 0.001) and death (hazard ratio: 3.9; 95% confidence interval: 1.5 to 10.1; p < 0.001), independent of revascularization, baseline LVEF, and medical therapy compared with patients with recovery. Similar findings were observed in the other cohorts. LVEF reassessments beyond 6 weeks post-MI were more predictive of outcome than were earlier reassessments.
Conclusions The degree of LVEF recovery after a first MI provides important prognostic information. Patients with no recovery in LVEF after MI are at high risk of sudden cardiac arrest events and death.
Dr. Chew is supported by an Arthur J.E. Child Cardiology Fellowship, and is a member of the Cardiac Arrhythmia Network of Canada (CANet) HQP Association for Trainees (CHAT). Dr. Exner has received consulting fees from GE Healthcare, Medtronic, Abbott Medical, Boston Scientific; and has equity in Analytics for Life. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received April 28, 2017.
- Revision received December 22, 2017.
- Accepted December 28, 2017.
- 2018 American College of Cardiology Foundation