Can Left Ventricular Systolic Function Estimated During Acute Coronary Syndrom Predict Long-Term Clinical Outcome?

Aim: of the study was to identify predictive role of left ventricular systolic function at the time of acute coronary event on mid-term clinical outcome of ACS patients.
Methods: patients with ACS, were subjected to analyze for variables such as: age, gender, risk factors, SBP and HR during ACS, type and treatment of MI, CAD extent and severity, LV function, post-discharge medications, type and time to event. Comparative analyze was performed between pts. with preserved and reduced LV systolic function at the time of ACS (EF >/£50%). Statistical analyze: descriptive and comparative analyze, uni and multivariate regression analyze, Caplan-Meier event free survival analyze.
Results: 284 patients treated for ACS, at mean age 61,1±11,4 y., 200 (70,4%) males and 84 (29,6%) females, were followed up for mean 33,7±11,4 months. A total of 100 (35,2%) patients had cardiac event (CE) during the 284pts./778 y. follow up, 4(1,4%) of which cardiac deaths (CD), 2 registered during the first 30 days. Ischemic events were the most frequent (32,7%), 6,3% of these were elective PCI procedures. Symptomatic HF (NYHA III, IV) was registered in 22 (7,7%) pts. 129 of whom were in group 1(EF 44±5,3%), and 139 pts. in group 0 (EF 58±5,7%); p=ns. Univariate predictors associated with reduced LVEF were: advanced age (p 0,008, exp(B)1,034); usage of diuretic therapy after the first event (p 0,044, exp(B) 1,087); AMI location-anterior (p 0,017, exp(B) 2,876); number of diseased CA (p 0,092; exp(B) 1,279; and HR p 0,001, exp(B) 1,025. While during multivariate analyze only diuretic therapy was associated with reduced LV systolic function (p 0,000). Kaplan Meier hazard curves for total cardiac events and for symptomatic heart failure reveled no significant differences (Table 1).
Conclusion: LV systolic function at the time of acute coronary event can influence the clinical course of events during the follow up period, but we were unable to determine statistical significance because of a small number of patients and/or registered events during the follow up period.

Table 1. Numerical parameters for cumulative survival curves

Image 1. Kaplan Meier’s cumulative hazard curves: a) any event; b) symptomatic HF