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

Abstract

BACKGROUND:

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.

• Authors: Gabriel C Brooks, Byron K Lee, Rajni Rao, Feng Lin, Daniel P Morin, Steven L Zweibel, Alfred E Buxton, Mark J Pletcher, Eric Vittinghoff, Jeffrey E Olgin, PREDICTS Investigators
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 67 Issue 10 Pg. 1186-1196 (Mar 15 2016) ISSN: 1558-3597 [Electronic] United States
• PMID: 26965540 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Topics

• Disease Progression
• Echocardiography
• Female
• Humans
• Male
• Middle Aged
• Myocardial Infarction (complications, mortality, surgery)
• Percutaneous Coronary Intervention
• Prognosis
• Prospective Studies
• Severity of Illness Index
• Stroke Volume (physiology)
• Survival Rate (trends)
• Systole
• Ventricular Dysfunction, Left (diagnosis, etiology, physiopathology)
• Ventricular Remodeling