Abstract 18073: Predictors of Reduced Left Ventricular Function in Patients With ST Elevation Myocardial Infarction After Primary Percutaneous Intervention: Propensity Score Matched Analysis
Background: There is a paucity of data about factors to predict reduced left ventricular (LV) ejection fraction (EF) after successful primary percutaneous intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).
Methods: We analyzed a total of 5,544 STEMI patients received successful PCI between 2011 and 2015. We categorized study population into two groups based on LVEF: group I (LVEF<40%, n=756 [13.6%]), and group II (LVEF≥40%, n=4,788 [86.4%]). Propensity score matching was applied to adjust for baseline clinical characteristics, creating a total of 2,268 patients: group I (n=756) and group II (n=1,512). A new prediction score system for LV dysfunction was established using the variables related with reduced LVEF in multivariate logistic regression analysis.
Results: In-hospital mortality was more frequently occurred in group I than group II even after propensity score matching (7.4% vs. 1.5%, p<0.001). On multivariate logistic regression analysis, old age (≥60years) (adjusted odds ratio [AOR] 1.37, 95% confidence interval [CI] 1.14-1.65, p=0.001), diabetes (AOR 1.56, 95% CI 1.30-1.87, p<0.001), previous myocardial infarction (AOR 2.67, 95% CI 1.99-3.57, p<0.001), chronic kidney disease (AOR 2.88, 95% CI 2.04-4.06, p<0.001), heart failure (AOR 2.47, 95% CI 1.23-4.97, p=0.011), atrial fibrillation (AOR 2.33, 95% CI 1.60-3.12, p<0.001), and delayed symptom to balloon time (>6hours) (AOR 1.55, 95% CI 1.28-1.88, p<0.001) were independently associated with reduced LVEF. After propensity score matching, left anterior descending (LAD) artery culprit location (AOR 3.437, 95% CI 2.83-4.17, p<0.001), complex lesion (AOR 1.51, 95% CI 1.12-2.03, p=0.007), and culprit only PCI (AOR 0.69, 95% CI 0.54-0.89, p=0.004) were related with LV dysfunction. The receiver-operating characteristics curve by a new prediction score system showed that the area under the curve was 0.719 (95% CI 0.70-0.74, p<0.001).
Conclusion: Reduced LVEF was significantly associated with in-hospital mortality in patients with STEMI even after successful revascularization. A new prediction score using several clinical, angiographic parameters of reduced LV function could be helpful for detecting high risk patients for LV dysfunction.
Author Disclosures: J. Lee: None. U. Kim: None. C. Lee: None. J. Son: None. J. Park: None. D. Shin: None. Y. Kim: None.
- © 2016 by American Heart Association, Inc.