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- Title
Względny wpływ frakcji wyrzutowej lewej komory i klasy czynnościowej NYHA przy wypisie na 3‑letnie rokowanie po zawale serca (analiza z rejestru PL‑ACS).
- Authors
Gierlotka, Marek; Tycińska, Agnieszka; Trzeciak, Przemysław; Feusette, Piotr; Kleinrok, Andrzej; Gąsior, Mariusz
- Abstract
BACKGROUND AND AIMS Heart failure (HF) is one of the main causes of poor outcomes after discharging home patients hospitalized due to acute myocardial infarction (AMI). The aim of this analysis was to assess the relative impact of left ventricle ejection fraction (LVEF) and functional status (NYHA class) at discharge on 3‑year outcomes after acute phase of AMI. METHODS We used the Polish Registry of Acute Coronary Syndromes (PL‑ACS) database (for baseline characteristics of AMI patients from years 2009–2011) linked to the database of the only health insurer in Poland (National Health Fund) for 3‑year follow‑up data, concerning rehospitalizations and total mortality. Several multivariate models were built to adjust the 3‑year outcomes for baseline clinical characteristics and treatments. RESULTS Altogether 52 086 patients with AMI (50.4%% NSTEMI and 49.6% STEMI), with known both LVEF and NYHA class at the time of discharging home were analysed. The distributions of LVEF at discharge were as follows: ≥50% – 54%, 40–49% – 29%, 30–39% – 12%, ≤29% – 5%, and NYHA classes: I – 62%, II – 32%, III or IV – 5%. The rate invasive treatment of AMI during index hospitalization was 94% and it varies between 80% and 97%, being lower in patients with lower LVEF and higher NYHA class. After 3 years follow up period 7844 (15%) of patients died, 31 046 (59.6%) were rehospitalized for cardiovascular reasons (CV), 6719 (12.9%) due to heart failure, 1309 (2.5%) had ICD or CRT‑D implanted, percutaneous revascularization was needed for 12 435 (23.9%) patients and surgical for 3580 (6.9%). In multivariate models both lower LVEF and higher NYHA class were significantly and additively associated with higher mortality, the risk of rehospitalization due to heart failure, as well as ICD or CRT‑D implantation. Additionally, lower LVEF, but not NYHA class, was significantly associated with higher risk of rehospitalization due to CV reasons. Higher NYHA class was significantly associated with lower rates of revascularizations procedures, while lower LVEF only modestly. Adjusted relative risk of 3‑year outcomes in the subgroups of patients according to LVEF and NYHA class at discharge are shown at the Figure 1. CONCLUSIONS Functional status assessed by NYHA class at discharge home from AMI has an important additive value to left ventricle ejection fraction in prediction of long‑term outcomes.
- Subjects
MYOCARDIAL infarction treatment; HEART failure risk factors; CONFERENCES &; conventions; HEART ventricles; LIFE skills; HEALTH outcome assessment; RISK assessment; VENTRICULAR ejection fraction
- Publication
Polish Heart Journal / Kardiologia Polska, 2020, Vol 78, p127
- ISSN
0022-9032
- Publication type
Article