Reductions in LVEF tied to mortality in seniors with NSTEMI

New-onset decreases in left ventricular ejection fraction (LVEF) is common among seniors with non-ST-segment elevation myocardial infarction (NSTEMI) and appears to amplify mortality risk, a recent study has found.

Researchers enrolled 6,287 elderly NSTEMI patients (mean age, 84.6±3.7 years; 50 percent male), of whom 60 percent had normal, 20 percent had mildly reduced, 14 percent had moderately reduced and 6 percent had severely reduced LVEF, respectively. Primary outcome was all-cause mortality.

Over a median follow-up of 2.4 years, 2,211 deaths occurred. The resulting incidence rates per category of LVEF reduction were 11, 16, 23 and 44 deaths per 100 person-years, respectively; 1,042 of these deaths occurred within 1 year of follow-up.

Adjusting for confounders showed that the risk of all-cause death was significantly higher in patients with mild (hazard ratio [HR], 1.44, 95 percent CI, 1.25–1.65), moderate (HR 1.93, 1.67–2.23) and severe (HR, 3.24, 2.74–3.85) reductions in LVEF, as compared with those who had normal LVEF.

LVEF reduction had a similar effect on short-term mortality. There were 306 deaths within 30 days of admission. Analysis according to LVEF categories showed that the respective incidence rates were 28, 48, 117 and 304 deaths per person-year in the normal, mild, moderate and severe reduction groups.

In particular, patients with moderate (HR, 3.59, 2.47–5.21) and severe (HR, 3.59, 2.47–5.21) LVEF reductions had strong and significant mortality risk exacerbations.