Effect of age on the prognostic value of left ventricular function in patients with acute coronary syndrome: a prospective registry study

Chun Shing Kwok, Max O. Bachmann, Mamas A. Mamas, Susan Stirling, Lee Shepstone, Phyo Kyaw Myint, M. Justin Zaman

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Abstract

Objective: This study aims to study the prognostic impact of LV function on mortality and examine the effect of age on the prognostic value of left ventricular function.  Methods: We examined the Myocardial Ischaemia National Audit Project (MINAP) registry (2006-2010) data with a mean follow up of 2.1 years. LV function was categorized into good (ejection fraction (EF) ≥50%), moderate (EF 30-49%) and poor (EF <30%) categories. Cox-proportional hazards models were constructed to examine the prognostic significance of LV function in different age groups (<65, 65-74, 75-84 and ≥85 years) on all-cause mortality adjusting for baseline variables.  Results: Of 424,848 patients, LV function data available for 123,609. Multiple imputations were used to impute missing values of LV function and the final sample for analyses were drawn from 414,305. After controlling for confounders, 339,887 participants were included in the regression models. For any age group, mortality was higher with worsening degree of LV impairment. Increased age reduced the adverse prognosis associated with reduced LV function (hazard ratios (HRs) of death comparing poor LV function to good LV function were 2.11 95%CI 1.88-2.37 for age <65 years and 1.28 95%CI 1.20-1.36 for age ≥85 years. Older patients had a high mortality risk even in those with good LV function. HRs of mortality for ≥85 compared to <65 years (HR=1.00) within good, moderate and poor ejection fractions groups were 5.89, 4.86 and 3.43, respectively.  Conclusions: In patients with ACS, clinicians should interpret the prognostic value of LV function taking into account patient’s age.
Original languageEnglish
Pages (from-to)191-198
Number of pages8
JournalEuropean Heart Journal: Acute Cardiovascular Care
Volume6
Issue number2
Early online date16 Dec 2015
DOIs
Publication statusPublished - 1 Mar 2017

Keywords

  • Acute coronary syndrome
  • age
  • left ventricular function
  • mortality

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