Comparison of three-year outcomes after primary percutaneous coronary intervention in patients with left ventricular ejection fraction <40% versus ≥40% (from the HORIZONS-AMI Trial)

Benoit Daneault, Philippe Généreux, Ajay J. Kirtane, Bernhard Witzenbichler, Giulio Guagliumi, Jean Michel Paradis, Martin P. Fahy, Roxana Mehran, Gregg W. Stone

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Left ventricular (LV) dysfunction and multivessel disease (MVD) have been associated with greater mortality after ST-segment elevation myocardial infarction. The aim of this study was to evaluate the impact of LV dysfunction and MVD in patients with ST-segment elevation myocardial infarctions treated with primary percutaneous coronary intervention (PCI). Patients from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial treated with primary PCI in whom baseline LV function was assessed using left ventriculography were included in this study. Early and late (3-year) outcomes were examined in groups of patients with reduced (<40%) and preserved (≥40%) LV ejection fractions (LVEFs), further stratified by the presence of MVD. A total of 2,430 patients were included. Patients with reduced LVEFs were older; were more likely to be women; were more likely to have histories of myocardial infarction, PCI, and heart failure; and were more likely to present in heart failure. Patients with reduced LVEFs had greater 30-day (8.9% vs 0.9%, hazard ratio 9.81, 95% confidence interval 5.23 to 18.42, p <0.0001) and 3-year (17.1% vs 3.7%, hazard ratio 5.03, 95% confidence interval 3.37 to 7.50, p <0.0001) mortality. Among patients with LVEFs <30% (n = 45), 30% to 40% (n = 157), 40% to 50% (n = 373), 50% to 60% (n = 659), and ≥60% (n = 1,196), 3-year mortality was 29.4%, 13.5%, 6.4%, 3.8%, and 2.9%, respectively (p for trend <0.0001). MVD was associated with greater mortality in patients with preserved but not reduced LVEFs. By multivariate analysis, LV dysfunction was the strongest predictor of 30-day and 3-year mortality. In conclusion, the presence of LV dysfunction as assessed on baseline left ventriculography in patients who undergo primary PCI in the contemporary era is a powerful predictor of early and late mortality, regardless of the extent of coronary artery disease.

Original languageEnglish (US)
Pages (from-to)12-20
Number of pages9
JournalAmerican Journal of Cardiology
Volume111
Issue number1
DOIs
StatePublished - Jan 1 2013
Externally publishedYes

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Percutaneous Coronary Intervention
Stroke Volume
Stents
Myocardial Infarction
Left Ventricular Dysfunction
Mortality
Heart Failure
Confidence Intervals
Left Ventricular Function
Coronary Artery Disease
Multivariate Analysis

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Daneault, Benoit ; Généreux, Philippe ; Kirtane, Ajay J. ; Witzenbichler, Bernhard ; Guagliumi, Giulio ; Paradis, Jean Michel ; Fahy, Martin P. ; Mehran, Roxana ; Stone, Gregg W. / Comparison of three-year outcomes after primary percutaneous coronary intervention in patients with left ventricular ejection fraction <40% versus ≥40% (from the HORIZONS-AMI Trial). In: American Journal of Cardiology. 2013 ; Vol. 111, No. 1. pp. 12-20.
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abstract = "Left ventricular (LV) dysfunction and multivessel disease (MVD) have been associated with greater mortality after ST-segment elevation myocardial infarction. The aim of this study was to evaluate the impact of LV dysfunction and MVD in patients with ST-segment elevation myocardial infarctions treated with primary percutaneous coronary intervention (PCI). Patients from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial treated with primary PCI in whom baseline LV function was assessed using left ventriculography were included in this study. Early and late (3-year) outcomes were examined in groups of patients with reduced (<40{\%}) and preserved (≥40{\%}) LV ejection fractions (LVEFs), further stratified by the presence of MVD. A total of 2,430 patients were included. Patients with reduced LVEFs were older; were more likely to be women; were more likely to have histories of myocardial infarction, PCI, and heart failure; and were more likely to present in heart failure. Patients with reduced LVEFs had greater 30-day (8.9{\%} vs 0.9{\%}, hazard ratio 9.81, 95{\%} confidence interval 5.23 to 18.42, p <0.0001) and 3-year (17.1{\%} vs 3.7{\%}, hazard ratio 5.03, 95{\%} confidence interval 3.37 to 7.50, p <0.0001) mortality. Among patients with LVEFs <30{\%} (n = 45), 30{\%} to 40{\%} (n = 157), 40{\%} to 50{\%} (n = 373), 50{\%} to 60{\%} (n = 659), and ≥60{\%} (n = 1,196), 3-year mortality was 29.4{\%}, 13.5{\%}, 6.4{\%}, 3.8{\%}, and 2.9{\%}, respectively (p for trend <0.0001). MVD was associated with greater mortality in patients with preserved but not reduced LVEFs. By multivariate analysis, LV dysfunction was the strongest predictor of 30-day and 3-year mortality. In conclusion, the presence of LV dysfunction as assessed on baseline left ventriculography in patients who undergo primary PCI in the contemporary era is a powerful predictor of early and late mortality, regardless of the extent of coronary artery disease.",
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Comparison of three-year outcomes after primary percutaneous coronary intervention in patients with left ventricular ejection fraction <40% versus ≥40% (from the HORIZONS-AMI Trial). / Daneault, Benoit; Généreux, Philippe; Kirtane, Ajay J.; Witzenbichler, Bernhard; Guagliumi, Giulio; Paradis, Jean Michel; Fahy, Martin P.; Mehran, Roxana; Stone, Gregg W.

In: American Journal of Cardiology, Vol. 111, No. 1, 01.01.2013, p. 12-20.

Research output: Contribution to journalArticle

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T1 - Comparison of three-year outcomes after primary percutaneous coronary intervention in patients with left ventricular ejection fraction <40% versus ≥40% (from the HORIZONS-AMI Trial)

AU - Daneault, Benoit

AU - Généreux, Philippe

AU - Kirtane, Ajay J.

AU - Witzenbichler, Bernhard

AU - Guagliumi, Giulio

AU - Paradis, Jean Michel

AU - Fahy, Martin P.

AU - Mehran, Roxana

AU - Stone, Gregg W.

PY - 2013/1/1

Y1 - 2013/1/1

N2 - Left ventricular (LV) dysfunction and multivessel disease (MVD) have been associated with greater mortality after ST-segment elevation myocardial infarction. The aim of this study was to evaluate the impact of LV dysfunction and MVD in patients with ST-segment elevation myocardial infarctions treated with primary percutaneous coronary intervention (PCI). Patients from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial treated with primary PCI in whom baseline LV function was assessed using left ventriculography were included in this study. Early and late (3-year) outcomes were examined in groups of patients with reduced (<40%) and preserved (≥40%) LV ejection fractions (LVEFs), further stratified by the presence of MVD. A total of 2,430 patients were included. Patients with reduced LVEFs were older; were more likely to be women; were more likely to have histories of myocardial infarction, PCI, and heart failure; and were more likely to present in heart failure. Patients with reduced LVEFs had greater 30-day (8.9% vs 0.9%, hazard ratio 9.81, 95% confidence interval 5.23 to 18.42, p <0.0001) and 3-year (17.1% vs 3.7%, hazard ratio 5.03, 95% confidence interval 3.37 to 7.50, p <0.0001) mortality. Among patients with LVEFs <30% (n = 45), 30% to 40% (n = 157), 40% to 50% (n = 373), 50% to 60% (n = 659), and ≥60% (n = 1,196), 3-year mortality was 29.4%, 13.5%, 6.4%, 3.8%, and 2.9%, respectively (p for trend <0.0001). MVD was associated with greater mortality in patients with preserved but not reduced LVEFs. By multivariate analysis, LV dysfunction was the strongest predictor of 30-day and 3-year mortality. In conclusion, the presence of LV dysfunction as assessed on baseline left ventriculography in patients who undergo primary PCI in the contemporary era is a powerful predictor of early and late mortality, regardless of the extent of coronary artery disease.

AB - Left ventricular (LV) dysfunction and multivessel disease (MVD) have been associated with greater mortality after ST-segment elevation myocardial infarction. The aim of this study was to evaluate the impact of LV dysfunction and MVD in patients with ST-segment elevation myocardial infarctions treated with primary percutaneous coronary intervention (PCI). Patients from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial treated with primary PCI in whom baseline LV function was assessed using left ventriculography were included in this study. Early and late (3-year) outcomes were examined in groups of patients with reduced (<40%) and preserved (≥40%) LV ejection fractions (LVEFs), further stratified by the presence of MVD. A total of 2,430 patients were included. Patients with reduced LVEFs were older; were more likely to be women; were more likely to have histories of myocardial infarction, PCI, and heart failure; and were more likely to present in heart failure. Patients with reduced LVEFs had greater 30-day (8.9% vs 0.9%, hazard ratio 9.81, 95% confidence interval 5.23 to 18.42, p <0.0001) and 3-year (17.1% vs 3.7%, hazard ratio 5.03, 95% confidence interval 3.37 to 7.50, p <0.0001) mortality. Among patients with LVEFs <30% (n = 45), 30% to 40% (n = 157), 40% to 50% (n = 373), 50% to 60% (n = 659), and ≥60% (n = 1,196), 3-year mortality was 29.4%, 13.5%, 6.4%, 3.8%, and 2.9%, respectively (p for trend <0.0001). MVD was associated with greater mortality in patients with preserved but not reduced LVEFs. By multivariate analysis, LV dysfunction was the strongest predictor of 30-day and 3-year mortality. In conclusion, the presence of LV dysfunction as assessed on baseline left ventriculography in patients who undergo primary PCI in the contemporary era is a powerful predictor of early and late mortality, regardless of the extent of coronary artery disease.

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