Abstract 17600: Risk Stratification Using Biomarker for Fatal Arrhythmic Events Following Acute Myocardial Infarction Complicated With Left Ventricular Dysfunction in the Reperfusion Era
Background: To stratify the patients with later fatal arrhythmia event (FAE) following acute myocardial infarction (AMI), its determinants in the reperfusion era still remain uncertain.
Methods: Among consecutive 2450 AMI patients hospitalized in our hospital between 2000 to 2013, 430 patients (72% received primary percutaneous coronary intervention) with left ventricular ejection fraction (LVEF) of 40% or less were retrospectively analyzed.
Results: During mean follow-up period of 66±49 months, 25 of 430 patients (5.8%, 1.1%/year) developed FAE, defined as composite of sudden death, lethal ventricular tachyarrhythmia (VT) and appropriate implantable cardioverter-defibrillator (ICD) therapy and 15 of 25 patients (60%) developed FAE more than 1 year after discharge. Patients with FAE showed lower LVEF (median 26 [interquartile range 23-32] vs. 34% [30-38]), higher plasma brain natriuretic peptide (BNP) levels (388 [292-820] vs. 280 pg/ml [149-500]), larger left ventricular diastolic diameter on echocardiography (58 [50-62] vs. 52 mm [47-57]) and broader QRS width on elecrocardiography (104 [93-114] vs. 96 msec [88-108]), as well as higher prevalence of lethal VT during hospitalization (16 vs. 2%) compared with those without it. Among FAE patients, BNP level was higher (297 [173-525] vs. 106 pg/ml [51-218]) and LVEF was lower (24 [16-38] vs. 40% [33-46]) at 1 year than those in non-FAE patients (all p<0.05). Receiver operating characteristic analysis revealed that the optimal cut-off value of LVEF and BNP levels at discharge to predict FAE were 32% and 225 pg/ml (Area under the curve (AUC) 0.765 and 0.673, respectively) and those at 1 year were 31% and 144 pg/ml (AUC 0.772 and 0.813, respectively).
Conclusions: In the current reperfusion era, 60% of FAE developed more than 1 year following AMI. In patients with left ventricular dysfunction, as well as LVEF, BNP levels seem to be useful to predict FAE and should be assessed in the chronic phase.
Author Disclosures: N. Konagai: None. Y. Asaumi: None. T. Shibata: None. N. Moriyama: None. K. Nishimura: None. T. Nakashima: None. S. Kawakami: None. M. Fujino: None. K. Nakao: None. T. Nagai: None. K. Nishihira: None. R. Kumasaka: None. T. Arakawa: None. T. Kanaya: None. Y. Kataoka: None. Y. Tahara: None. M. Nakanishi: None. T. Noguchi: None. S. Yasuda: None.
- © 2016 by American Heart Association, Inc.