CLINICAL STUDY
The relationships of left ventricular ejection fraction, end-systolic volume index and infarct size to six-month mortality after hospital discharge following myocardial infarction treated by thrombolysis
Robert J. Burns, MD, FACC*,1,
Raymond J. Gibbons, MD, FACC ,*,
Qilong Yi, MSc¶,
Robin S. Roberts, MTech ,
Todd D. Miller, MD, FACC,
Gary L. Schaer, MD, FACC ,
Jeffrey L. Anderson, MD, FACC||,
Salim Yusuf, MB, BS, PhD, FACC¶ CORE Study Investigators
* Toronto Hospital, Toronto, Ontario, Canada
Mayo Clinic, Rochester, Minnesota, USA
Hamilton Civic Hospitals Research Centre, Hamilton, Ontario, Canada
Rush-Presbyterian-St. Luke’s Medical Center, Chicago, Illinois, USA
|| University of Utah, Salt Lake City, Utah, USA
¶ Hamilton General Hospital, Hamilton, Ontario, Canada
Manuscript received October 18, 2000;
revised manuscript received September 24, 2001,
accepted October 11, 2001.
* Reprint requests and correspondence: Dr. Raymond J. Gibbons, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
gibbons.raymond{at}mayo.edu
OBJECTIVES: We sought to relate left ventricular ejection fraction (EF), end-systolic volume index (ESVI) and infarct size (IS), as measured in a single randomized trial, to six-month mortality after myocardial infarction (MI) treated with thrombolysis.
BACKGROUND: These three prognostic indicators have never been compared in the same study group.
METHODS: Radionuclide angiographic and single-photon emission computed tomographic sestamibi measurements of IS were performed in 1,194 and 1,181 patients, respectively, of the 2,948 patients enrolled in the Collaborative Organization for RheothRx Evaluation (CORE) trial. Ejection fraction, ESVI and IS, as measured by central laboratories in these radionuclide substudies, were tested for their association with six-month mortality.
RESULTS: Ejection fraction (n = 1,137; p < 0.0001), ESVI (n = 945; p = 0.055) and IS (n = 1,164; p = 0.03) were all associated with six-month mortality. Each of these measurements was significantly correlated with the other two, regardless of MI location. In an "overlap" group of 753 patients (25.5% of the population; 13 deaths) in whom all three measurements were available, EF (p = 0.001) was a stronger predictor than ESVI (p = 0.005) or IS (p = 0.01). Neither of the other two measurements added independent prognostic information. The highest risk subgroup (EF < 30%) had an 11% six-month mortality, but comprised only 95 patients (8.3%).
CONCLUSIONS: Ejection fraction, ESVI and IS measurements performed one to two weeks after MI can each predict six-month mortality. Ejection fraction was superior to the other two measurements. However, this study had limited power to detect independent significance of ESVI or IS.
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Abbreviations and Acronyms
| | CORE | | Collaborative Organization for RheothRx Evaluation | | EF | | ejection fraction | | ESVI | | end-systolic volume index | | IS | | infarct size | | LV | | left ventricular or ventricle | | MI | | myocardial infarction | | SPECT | | single-photon emission computed tomography | | 99mTc | | technetium-99m |
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