Reduced Left Ventricular Ejection Fraction as A Predictor In-Hospital Major Cardiovascular Event in Patients Admitted with Acute Myocardial Infarction at Sanglah General Hospital Bali
Author : I. D. G. D. Sumajaya, L. O. S. Suastika, A. A. A. D. A. Yasmin, I. G. N. P. Gunadhi
Upload Date : 19-04-2018
Background: Acute myocardial infarction, which consists of ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI), is still leading as cause of death worldwide. Proper recognition of high risk patient and early reperfusion strategy is vital to improve survival and also reduce morbidity and mortality. In this study, we investigate the role of left ventricular ejection fraction (LVEF) as a predictor of in-hospital major adverse cardiovascular event (MACE) in AMI patients.
Methods: This was a retrospective cohort study conducted at Sanglah Hospital Denpasar Bali, involving all AMI patients admitted during January 1st – December 31st 2016. All data including demographic, diagnosis, risk factors, echocardiography and MACE was collected from medical record, tabulated and analysis using computer software program.
Result: Majority of patients presented with STEMI (78.6%) diagnosis and MACE happened in 25 patients (35.7%). There are 16 (22.9%) patients with reduced LVEF and 54 (77.1%) patient with normal LVEF. In reduced LVEF group, there were 68.8% with MACE and 31.2% without MACE. Bivariate analysis showed that reduced LVEF had 6 times-fold risk of MACE compared to normal LVEF (HR 6.286, 95% CI 1.856-21.287). In multivariate analysis adjusted to other confounding variables, HR were 3.830 (95% CI 1.600-9.168, p=0.003), showing that reduced LVEF is an independent predictor of MACE. Survival analysis with Kaplan-Meier showed that patients with reduced LVEF had worse survival than normal LVEF (mean survival 56.313 hours, 95% CI 32.228-80.397, p=0.001).
Conclusion: This study showed the importance of LVEF assessment to predict worse outcome in AMI patient and may be a guidance whether early reperfusion strategy will be beneficial to reduce morbidity and even mortality.
KEYWORDS : Left ventricular ejection fraction; acute myocardial infarction; major adverse cardiovascular event.