Predicting Persistent Left Ventricular Dysfunction Following Myocardial Infarction: The PREDICTS Study

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• 作者：Gabriel C. Brooks ; MD^a ; Byron K. Lee ; MD ; MAS^a ; Rajni Rao ; MD^a ; Feng Lin ; MS^b ; Daniel P. Morin ; MD ; MPH^c ; ^d ; Steven L. Zweibel ; MD^e ; Alfred E. Buxton ; MD^f ; Mark J. Pletcher ; MD ; MPH^b ; Eric Vittinghoff ; PhD^b ; Jeffrey E. Olgin ; MD^a ; ^{jeffrey.olgin@ucsf.edu" class="auth_mail" title="E-mail the corresponding author} ; on behalf of the PREDICTS Investigators
• 关键词：heart failure ; remodeling ; risk assessment ; ventricular ejection fraction
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：15 March 2016
• 年：2016
• 卷：67
• 期：10
• 页码：1186-1196
• 全文大小：711 K

文摘

Persistent severe left ventricular (LV) systolic dysfunction after myocardial infarction (MI) is associated with increased mortality and is a class I indication for implantation of a cardioverter-defibrillator.

Objectives

This study developed models and assessed independent predictors of LV recovery to >35% and ≥50% after 90-day follow-up in patients presenting with acute MI and severe LV dysfunction.

Methods

Our multicenter prospective observational study enrolled participants with ejection fraction (EF) of ≤35% at the time of MI (n = 231). Predictors for EF recovery to >35% and ≥50% were identified after multivariate modeling and validated in a separate cohort (n = 236).

Results

In the PREDICTS (PREDiction of ICd Treatment Study) study, 43% of patients had persistent EF ≤35%, 31% had an EF of 36% to 49%, and 26% had an EF ≥50%. The model that best predicted recovery of EF to >35% included EF at presentation, length of stay, prior MI, lateral wall motion abnormality at presentation, and peak troponin. The model that best predicted recovery of EF to ≥50% included EF at presentation, peak troponin, prior MI, and presentation with ventricular fibrillation or cardiac arrest. After predictors were transformed into point scores, the lowest point scores predicted a 9% and 4% probability of EF recovery to >35% and ≥50%, respectively, whereas profiles with the highest point scores predicted an 87% and 49% probability of EF recovery to >35% and ≥50%, respectively.

Conclusions

In patients with severe systolic dysfunction following acute MI with an EF ≤35%, 57% had EF recovery to >35%. A model using clinical variables present at the time of MI can help predict EF recovery.