Abstract 2488: Can an Elderly Woman’s Heart be too Strong? Increased Mortality with High vs. Normal Ejection Fraction after an Acute Coronary Syndrome. The Global Registry of Acute Coronary Events
Background: Coronary artery disease (CAD) is the leading cause of death in elderly women.
Hypothesis: In women, a very high left-ventricular (LV) ejection fraction (EF) may correlate with increased mortality compared to normal EF.
Methods: Data from 5127 women aged >65 years enrolled in the Global Registry of Acute Coronary Events were analyzed. Patients were categorized according to their LVEF during hospitalization: Group I (N=2987) had an EF < 55%, Group II (N=1483) had an EF of 55%– 65% and Group III (N=657) had an EF > 65%. A 3-way chi-square test compared the 3 groups; a separate chi-square test was done to compare normal vs. high EF groups. Multiple logistic regression (adjusting for baseline characteristics and hospital events) was performed to assess the possible impact of high EF on outcomes in elderly women against normal EF. Endpoints included hospital death or recurrent MI, and 6-month death, stroke or rehospitalization.
Results: Outcomes were highest in Group I. Hospital death rate was 12% in Group I vs. 1.8% in Group II and 2.8% in Group III (P <0.001). Patients in Group III had a higher risk of hospital death than those in Group II (P=0.003). Among women with LVEF > 55%, multivariable logistic regression model showed that high EF is an independent predictor of hospital death (OR 2.47, 95% CI 1.22– 4.96, C-statistic 0.85) and 6-month death (OR 1.8, 95% CI 1.07–2.95, C-statistic 0.82).
Conclusions: In women with preserved LV function, a high LVEF (>65%) is associated with lower hospital survival. Mechanisms underlying this association are unknown, but one possibility is that a mismatch between coronary supply and myocardial demand leads to ischemia-mediated arrhythmias.