Reduced vs. Preserved Left Ventricular Ejection Fraction in Acute Coronary Syndrome Patients – Trend in Prognosis Over a Decade

Introduction: Data regarding long-term prognosis trend in relation to left ventricular ejection fraction (LVEF) in patients presenting with acute coronary syndrome (ACS) is limited.

Method: We aimed to evaluate the rate and long-term prognosis trend of reduced vs. preserved LVEF between two periods of time (i.e. years 2000-2006 – early period vs. 2008-2016 – late period) in patients presenting with ACS. Patients were enrolled from the acute coronary syndrome Israeli survey (ACSIS) between the years 2000-2016.

Results: Out of 11713 patients with known LVEF, 43% and 57% had preserved (>50%) vs. reduced LVEF, respectively. Significantly more patients presented with preserved LVEF in the late period as compared with the early period (51% vs. 33%, p<0.0001, respectively). Patients with reduced LVEF had higher 1 and 3-year all-cause mortality rates as compared with patients with preserved LVEF (13.8% vs. 3.6% for 1-year and 19.1% vs. 6% for 3-years, respectively; p50% vs. LVEF <50% in early as well as late periods, figure 1). Cox proportional hazard model showed that in contrary to patients with preserved LVEF who had similar prognosis regardless of the time period, patients with reduced LVEF had significantly better prognosis during the late period as compared to the early period (HR 0.79; 95% CI 0.70, 0.89, p=0.0001).

Conclusion: LVEF is an independent prognostic factor in patients presenting with ACS. Our data suggests that the medical and interventional progress in last years in the treatment of patients with ACS appears to improve the prognosis of patients with reduced LVEF, but not that of preserved LVEF. Further studies are needed to confirm this observation.

Click the link to view image: