Abstract 3150: Renal Dysfunction Influences the Relationship Between Left Ventricular Systolic Dysfunction and Survival in the Post-Myocardial Infarction Patient
LV systolic dysfunction (SD), a strong predictor of cardiovascular (CV) outcomes after myocardial infarction (MI), may not fully explain CV outcomes in the setting of renal dysfunction, which itself is associated with increased mortality and adverse CV outcomes. We explored the influence of renal function on the relationship between LVSD and outcome in survivors of MI. A total of 11182 patients from the VALsartan In Acute myocardial iNfarcTion Trial (VALIANT) were categorized by estimated glomerular filtration rate (eGFR), using the MDRD equation, (eGFR < 60, > = 60 mL/min/1.73m2) and by LV ejection fraction (LVEF < 20, 20 –29, 30 –39, 40 – 49, >= 50%). Event rates for mortality were calculated at different levels of eGFR and LVEF. Adjusted Cox proportional hazard model was used to assess the relationship between LVEF as a continuous variable, eGFR, and survival. Covariates in the final model included clinical factors that have been used in previous models of this population. Reduced eGFR and LVEF were independently associated with increased mortality and the combination was an incrementally potent predictor, with a significant interaction between eGFR and LVEF (P < 0.001). The adjusted risk of death for a 10 unit reduction in LVEF was 1.30 (95% CI 1.20, 1.40) in the entire cohort, 1.50 (95% CI 1.33, 1.68) in patients with eGFR >= 60, and 1.12 (95% CI 1.00, 1.25) in those with eGFR < 60. Renal dysfunction modifies the relationship between LVEF and survival following MI and provides supplementary information to LVEF in predicting survival. While a reduction in LVEF is a predictor of poor outcome, the predictive power of a lower LVEF is attenuated in patients with decreased eGFR.