Abstract 2270: What Are The Most Important Predictors of Mortality In Patients with Myocardial Infarction In The Troponin Era?
Background: Based on its superior sensitivity and specificity, troponin is now considered the diagnostic standard for myocardial infarction (MI). Most studies reporting outcomes in MI patients (pts) are limited by being determined in pts enrolled in clinical trials, which have specific inclusion and exclusion criteria, or were performed prior to the widespread use of troponin. In addition, Ejection Fraction (EF), one of the most important predictors of mortality, was assessed infrequently and often not reported. We therefore determined predictors of 1 year mortality in a large consecutive group of pts admitted from the Emergency Department (ED) with MI based on a troponin standard.
Methods: From 1996 –2002, 1,648 consecutive pts admitted from the ED were diagnosed with MI, of whom 1,506 (91%) had EF measured within 30 days of admission. An elevated TnI was defined using the ACC/ESC criteria, and an abnormal EF as <40%. Variables, including peak CK-MB and initial ECG results were entered into a multivariate model to determine mortality predictors.
Results: Overall one year mortality was 19%. ST elevation MI was present in 22%, and 11% had ST depression. Multivarate predictors of 1 year mortality are shown in the Table⇓. Surprisingly, peak CK-MB and initial ECG results were not predictive, as they were outweighed by EF, renal function and age.
Conclusions: In pts with MI based on a troponin standard, renal function, age and EF are the most important predictors of 1 year mortality.