Predictors of depressed left ventricular function in patients presenting with ST-elevation myocardial infarction

Prashant D. Bhave, Kurt S. Hoffmayer, Ehrin J. Armstrong, Sonia Garg, Ateet Patel, John S. MacGregor, John C. Stein, Scott Kinlay, Peter Ganz, James M. McCabe

Research output: Contribution to journalArticle

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Abstract

Early in the course of ST-segment elevation myocardial infarction (STEMI), therapies that may harm patients who develop left ventricular (LV) dysfunction, such as β-blockers, are often administered. The investigators analyzed the ACTIVATE-SF database, a registry of consecutive STEMI activations presenting to 2 medical centers at the University of California, San Francisco. LV dysfunction was defined as an ejection fraction ≤40% on echocardiography. Of 211 patients included in the analysis, 66 (31%) had LV ejection fractions ≤40%. Patients with LV dysfunction were older (63 ± 15 vs 56 ± 13 years, p = 0.002). In multivariate regression models, decreased renal function (reference group, creatinine <1.0 mg/dl; adjusted odds ratio [AOR] creatinine >1.5 mg/dl 6.35, 95% confidence interval [CI] 1.66 to 24.31, p = 0.007), a history of coronary artery disease (AOR 3.12, 95% CI 1.26 to 7.71, p = 0.014), ST-segment elevation >2 mm on 12-lead electrocardiography (AOR 2.78, 95% CI 1.31 to 5.87, p = 0.008), and need for mechanical ventilation (AOR 3.98, 95% CI 1.41 to 11.19, p = 0.009) increased the odds of LV dysfunction. Inferior ST-segment elevations were associated with 88% decreased odds of LV dysfunction (AOR 0.12, 95% CI 0.06 to 0.35, p <0.001). A prediction score using these characteristics stratified patients into low-, intermediate-, and high-risk groups for LV dysfunction; positive likelihood ratios for LV dysfunction in these groups were 0.07, 1.14, and 4.93, respectively. In conclusion, 5 key predictors of in-hospital LV dysfunction after STEMI were identified; a risk score based on these predictors helps to quickly identify patients presenting with STEMI who are at the highest risk for developing significant LV dysfunction and could guide optimal therapeutic choices.

Original languageEnglish (US)
Pages (from-to)327-331
Number of pages5
JournalAmerican Journal of Cardiology
Volume109
Issue number3
DOIs
StatePublished - Feb 1 2012
Externally publishedYes

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Left Ventricular Dysfunction
Left Ventricular Function
Confidence Intervals
Patient Harm
ST Elevation Myocardial Infarction
San Francisco
Artificial Respiration
Stroke Volume
Registries
Echocardiography
Coronary Artery Disease
Creatinine
Electrocardiography
Research Personnel
Databases
Kidney
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Bhave, P. D., Hoffmayer, K. S., Armstrong, E. J., Garg, S., Patel, A., MacGregor, J. S., ... McCabe, J. M. (2012). Predictors of depressed left ventricular function in patients presenting with ST-elevation myocardial infarction. American Journal of Cardiology, 109(3), 327-331. https://doi.org/10.1016/j.amjcard.2011.09.015

Predictors of depressed left ventricular function in patients presenting with ST-elevation myocardial infarction. / Bhave, Prashant D.; Hoffmayer, Kurt S.; Armstrong, Ehrin J.; Garg, Sonia; Patel, Ateet; MacGregor, John S.; Stein, John C.; Kinlay, Scott; Ganz, Peter; McCabe, James M.

In: American Journal of Cardiology, Vol. 109, No. 3, 01.02.2012, p. 327-331.

Research output: Contribution to journalArticle

Bhave, PD, Hoffmayer, KS, Armstrong, EJ, Garg, S, Patel, A, MacGregor, JS, Stein, JC, Kinlay, S, Ganz, P & McCabe, JM 2012, 'Predictors of depressed left ventricular function in patients presenting with ST-elevation myocardial infarction', American Journal of Cardiology, vol. 109, no. 3, pp. 327-331. https://doi.org/10.1016/j.amjcard.2011.09.015
Bhave, Prashant D. ; Hoffmayer, Kurt S. ; Armstrong, Ehrin J. ; Garg, Sonia ; Patel, Ateet ; MacGregor, John S. ; Stein, John C. ; Kinlay, Scott ; Ganz, Peter ; McCabe, James M. / Predictors of depressed left ventricular function in patients presenting with ST-elevation myocardial infarction. In: American Journal of Cardiology. 2012 ; Vol. 109, No. 3. pp. 327-331.
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abstract = "Early in the course of ST-segment elevation myocardial infarction (STEMI), therapies that may harm patients who develop left ventricular (LV) dysfunction, such as β-blockers, are often administered. The investigators analyzed the ACTIVATE-SF database, a registry of consecutive STEMI activations presenting to 2 medical centers at the University of California, San Francisco. LV dysfunction was defined as an ejection fraction ≤40{\%} on echocardiography. Of 211 patients included in the analysis, 66 (31{\%}) had LV ejection fractions ≤40{\%}. Patients with LV dysfunction were older (63 ± 15 vs 56 ± 13 years, p = 0.002). In multivariate regression models, decreased renal function (reference group, creatinine <1.0 mg/dl; adjusted odds ratio [AOR] creatinine >1.5 mg/dl 6.35, 95{\%} confidence interval [CI] 1.66 to 24.31, p = 0.007), a history of coronary artery disease (AOR 3.12, 95{\%} CI 1.26 to 7.71, p = 0.014), ST-segment elevation >2 mm on 12-lead electrocardiography (AOR 2.78, 95{\%} CI 1.31 to 5.87, p = 0.008), and need for mechanical ventilation (AOR 3.98, 95{\%} CI 1.41 to 11.19, p = 0.009) increased the odds of LV dysfunction. Inferior ST-segment elevations were associated with 88{\%} decreased odds of LV dysfunction (AOR 0.12, 95{\%} CI 0.06 to 0.35, p <0.001). A prediction score using these characteristics stratified patients into low-, intermediate-, and high-risk groups for LV dysfunction; positive likelihood ratios for LV dysfunction in these groups were 0.07, 1.14, and 4.93, respectively. In conclusion, 5 key predictors of in-hospital LV dysfunction after STEMI were identified; a risk score based on these predictors helps to quickly identify patients presenting with STEMI who are at the highest risk for developing significant LV dysfunction and could guide optimal therapeutic choices.",
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