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

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE: This study aims to study the prognostic impact of left ventricular 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 registry (2006-2010) data with a mean follow-up of 2.1 years. Left ventricular function was categorised into good (ejection fraction ⩾50%), moderate (ejection fraction 30-49%) and poor (ejection fraction <30%) categories. Cox proportional hazards models were constructed to examine the prognostic significance of left ventricular function in different age groups (<65, 65-74, 75-84 and ⩾85 years) on all-cause mortality adjusting for baseline variables.

RESULTS: Out of 424,848 patients, left ventricular function data were available for 123,609. Multiple imputations were used to impute missing values of left ventricular function and the final sample for analyses was 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 a worsening degree of left ventricular impairment. Increased age reduced the adverse prognosis associated with reduced left ventricular function (hazard ratios of death comparing poor left ventricular function to good left ventricular function were 2.11, 95% confidence interval 1.88-2.37 for age <65 years and 1.28, 95% confidence interval 1.20-1.36 for age ⩾85 years). Older patients had a high mortality risk even in those with good left ventricular function. Hazard ratios of mortality for ⩾85 compared to <65 years (hazard ratio = 1.00) within good, moderate and poor ejection fraction groups were 5.89, 4.86 and 3.43, respectively.

CONCLUSIONS: In patients with acute coronary syndrome, clinicians should interpret the prognostic value of left ventricular function taking into account the 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

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Acute Coronary Syndrome
Left Ventricular Function
Registries
Prospective Studies
Mortality
Age Groups
Confidence Intervals
Proportional Hazards Models
Myocardial Ischemia

Keywords

  • myocardial infarction
  • older adults
  • ejection fraction
  • acute coronary syndrome
  • age
  • left ventricular function
  • mortality

Cite this

Effect of age on the prognostic value of left ventricular function in patients with acute coronary syndrome : A prospective registry study. / Kwok, Chun Shing; Bachmann, Max O; Mamas, Mamas A; Stirling, Susan; Shepstone, Lee; Myint, Phyo Kyaw; Zaman, M Justin.

In: European heart journal. Acute cardiovascular care, Vol. 6, No. 2, 01.03.2017, p. 191-198.

Research output: Contribution to journalArticle

Kwok, Chun Shing ; Bachmann, Max O ; Mamas, Mamas A ; Stirling, Susan ; Shepstone, Lee ; Myint, Phyo Kyaw ; Zaman, M Justin. / Effect of age on the prognostic value of left ventricular function in patients with acute coronary syndrome : A prospective registry study. In: European heart journal. Acute cardiovascular care. 2017 ; Vol. 6, No. 2. pp. 191-198.
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abstract = "OBJECTIVE: This study aims to study the prognostic impact of left ventricular 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 registry (2006-2010) data with a mean follow-up of 2.1 years. Left ventricular function was categorised into good (ejection fraction ⩾50{\%}), moderate (ejection fraction 30-49{\%}) and poor (ejection fraction <30{\%}) categories. Cox proportional hazards models were constructed to examine the prognostic significance of left ventricular function in different age groups (<65, 65-74, 75-84 and ⩾85 years) on all-cause mortality adjusting for baseline variables.RESULTS: Out of 424,848 patients, left ventricular function data were available for 123,609. Multiple imputations were used to impute missing values of left ventricular function and the final sample for analyses was 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 a worsening degree of left ventricular impairment. Increased age reduced the adverse prognosis associated with reduced left ventricular function (hazard ratios of death comparing poor left ventricular function to good left ventricular function were 2.11, 95{\%} confidence interval 1.88-2.37 for age <65 years and 1.28, 95{\%} confidence interval 1.20-1.36 for age ⩾85 years). Older patients had a high mortality risk even in those with good left ventricular function. Hazard ratios of mortality for ⩾85 compared to <65 years (hazard ratio = 1.00) within good, moderate and poor ejection fraction groups were 5.89, 4.86 and 3.43, respectively.CONCLUSIONS: In patients with acute coronary syndrome, clinicians should interpret the prognostic value of left ventricular function taking into account the patient's age.",
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T1 - Effect of age on the prognostic value of left ventricular function in patients with acute coronary syndrome

T2 - A prospective registry study

AU - Kwok, Chun Shing

AU - Bachmann, Max O

AU - Mamas, Mamas A

AU - Stirling, Susan

AU - Shepstone, Lee

AU - Myint, Phyo Kyaw

AU - Zaman, M Justin

N1 - © The European Society of Cardiology 2015. Funding The project was funded by the Sir Halley Stewart Trust. MINAP is funded by the Health Quality Improvement Partnership (HQIP).

PY - 2017/3/1

Y1 - 2017/3/1

N2 - OBJECTIVE: This study aims to study the prognostic impact of left ventricular 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 registry (2006-2010) data with a mean follow-up of 2.1 years. Left ventricular function was categorised into good (ejection fraction ⩾50%), moderate (ejection fraction 30-49%) and poor (ejection fraction <30%) categories. Cox proportional hazards models were constructed to examine the prognostic significance of left ventricular function in different age groups (<65, 65-74, 75-84 and ⩾85 years) on all-cause mortality adjusting for baseline variables.RESULTS: Out of 424,848 patients, left ventricular function data were available for 123,609. Multiple imputations were used to impute missing values of left ventricular function and the final sample for analyses was 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 a worsening degree of left ventricular impairment. Increased age reduced the adverse prognosis associated with reduced left ventricular function (hazard ratios of death comparing poor left ventricular function to good left ventricular function were 2.11, 95% confidence interval 1.88-2.37 for age <65 years and 1.28, 95% confidence interval 1.20-1.36 for age ⩾85 years). Older patients had a high mortality risk even in those with good left ventricular function. Hazard ratios of mortality for ⩾85 compared to <65 years (hazard ratio = 1.00) within good, moderate and poor ejection fraction groups were 5.89, 4.86 and 3.43, respectively.CONCLUSIONS: In patients with acute coronary syndrome, clinicians should interpret the prognostic value of left ventricular function taking into account the patient's age.

AB - OBJECTIVE: This study aims to study the prognostic impact of left ventricular 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 registry (2006-2010) data with a mean follow-up of 2.1 years. Left ventricular function was categorised into good (ejection fraction ⩾50%), moderate (ejection fraction 30-49%) and poor (ejection fraction <30%) categories. Cox proportional hazards models were constructed to examine the prognostic significance of left ventricular function in different age groups (<65, 65-74, 75-84 and ⩾85 years) on all-cause mortality adjusting for baseline variables.RESULTS: Out of 424,848 patients, left ventricular function data were available for 123,609. Multiple imputations were used to impute missing values of left ventricular function and the final sample for analyses was 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 a worsening degree of left ventricular impairment. Increased age reduced the adverse prognosis associated with reduced left ventricular function (hazard ratios of death comparing poor left ventricular function to good left ventricular function were 2.11, 95% confidence interval 1.88-2.37 for age <65 years and 1.28, 95% confidence interval 1.20-1.36 for age ⩾85 years). Older patients had a high mortality risk even in those with good left ventricular function. Hazard ratios of mortality for ⩾85 compared to <65 years (hazard ratio = 1.00) within good, moderate and poor ejection fraction groups were 5.89, 4.86 and 3.43, respectively.CONCLUSIONS: In patients with acute coronary syndrome, clinicians should interpret the prognostic value of left ventricular function taking into account the patient's age.

KW - myocardial infarction

KW - older adults

KW - ejection fraction

KW - acute coronary syndrome

KW - age

KW - left ventricular function

KW - mortality

U2 - 10.1177/2048872615623038

DO - 10.1177/2048872615623038

M3 - Article

C2 - 26676673

VL - 6

SP - 191

EP - 198

JO - European heart journal. Acute cardiovascular care

JF - European heart journal. Acute cardiovascular care

SN - 2048-8726

IS - 2

ER -