Abstract 15085: High Frequency of Duplicate Measures of Ejection Fraction in Hospitalized Patients with ST-Elevation Myocardial Infarction
Among pts with acute ST-elevation MI (STEMI) assessment of ejection fraction (EF) is a Class I recommendation. Accepted methods are echocardiography (TTE) and contrast ventriculography (VG). With reperfusion being standard therapy, STEMI pts often have concomitant VG. While TTE may be requested for various in-hospital indications, performance only to assess EF when VG has been done would be considered duplicative.
Methods: The records of 347 consecutive STEMI pts (age 60±13 yr, 72% men, 70% Killip I) presenting to a university center from 2008-10 were reviewed to assess the frequency and specific indications for EF testing by VG and TTE. When VG was performed first indications considered appropriate for TTE included change in hemodynamic status, suspected mechanical complication, new CHF, suspected valve or pericardial disease, pre-CABG, or suspected LV thrombus. Indications such as “assess EF” or “wall motion” were considered as inappropriate.
Results: All pts had EF measured; VG was performed in 345 pts (99%) and TTE in 311 (90%). VG was the test performed first in 342 pts (98%); TTE was performed in 306 (89%) of these pts often within 24 hours of VG (70%). Among this group 114 (37%) had an “appropriate” indication while the majority (n=192) did not. Among this majority, 86% were Killip class I and more often male and younger compared to the entire population. In the TTE-first group, 3 had EF also assessed by VG.
Conclusions: In this contemporary STEMI cohort: (1) EF was assessed in all pts as recommended. (2) Virtually all pts had EF assessed acutely by VG and a large majority (89%) subsequently had TTE. (3) While TTE was often requested for appropriate indications among VG-first pts, the majority of TTEs (63%) performed were for indications deemed “inappropriate.” Similar considerations applied when TTE was performed first. (4) This usage pattern, providing no new essential information, should be discouraged as it over-utilizes resources and increases healthcare costs.
- © 2011 by American Heart Association, Inc.