Abstract 3490: The Presence of Congestive Heart Failure Modulates the Ability of Ejection Fraction to Predict Mortality in Patients Admitted For Possible Myocardial Infarction
Background: Both congestive heart failure (CHF) and ejection fraction (EF) have been shown to be powerful predictors of outcome in ACS patients (pts). However, few studies have included both variables, as EF has been measured only infrequently.
Methods: Consecutive pts admitted for MI exclusion underwent serial assessment of CK, CK-MB and TnI. CHF was assessed at the time of admission using physical exam and chest x-ray findings. Abnormal EF was defined as >40%. One year mortality was assessed and results reported based on the presence of abnormal EF, TnI elevations and CHF.
Results: Over a 4 year period, 4,343 consecutive pts without ST elevation on the initial ECG were admitted, of whom 3,584 (83%, including 94% of those who were TnI (+)) had EF assessed. A total of 652 pts (18%) had TnI elevations. One year mortality is shown in the Figure⇓. Pts with EF≤40% had a significantly higher (p<0.001) mortality compared to those with an EF > 40%, both in the presence and absence of CHF. For each EF category, the presence of CHF significantly increased mortality two-fold or more (p<0.001) in all groups. Abnormal EF or CHF resulted in an approximately two-fold increase in mortality in pts who did and did not have TnI elevations.
Conclusions: The presence of CHF in pts with both normal and abnormal EF doubles mortality in pts admitted for possible MI.