Anwar J Siddiqui1, Martin J Holzmann2. 1. Department of Medicine, Karolinska Institutet, Solna, SE 171 71 Stockholm, Sweden; Functional Area of Emergency Medicine, Karolinska University Hospital, Huddinge, SE 141 86 Stockholm, Sweden. Electronic address: anwar.siddiqui@sll.se. 2. Department of Medicine, Karolinska Institutet, Solna, SE 171 71 Stockholm, Sweden; Functional Area of Emergency Medicine, Karolinska University Hospital, Huddinge, SE 141 86 Stockholm, Sweden.
Abstract
OBJECTIVES: We sought to investigate the association between LVEF and clinical outcomes after NSTEMI, and the benefit of guideline-recommended pharmacotherapy in elderly patients. BACKGROUND: New-onset reduction in LVEF is common after NSTEMI in patients of advanced age. There is little information about outcomes in relation to LVEF, and the benefit of guideline-recommended pharmacotherapy in elderly patients. MATERIALS AND METHODS: The SWEDEHEART registry was used to identify all patients in Sweden >80 years with NSTEMI from 2011 to 2014. A normal LVEF was defined as >50%; mildly reduced, 40%-49%; moderately reduced, 30%-39%; and severely reduced, <30%. Cox regression was used to calculate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for the association between a reduced LVEF compared with a normal LVEF and all-cause mortality. Similarly, the presence versus absence of treatment with guideline-recommended medications at discharge and mortality was evaluated. RESULTS: 6287 patients were included where 59%, 20%, 13%, and 6% had a normal, mildly reduced, moderately reduced, and severely reduced LVEF, respectively. During a median follow-up of 2.4 years, 2211 (35%) patients died. All three categories of impaired LVEF were associated with higher mortality: mildly reduced (1.44, 1.25-1.65), moderately reduced (1.93, 1.67-2.23), and severely reduced (3.24, 2.74-3.85). Patients who were treated with beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, or statins at discharge had lower mortality. CONCLUSIONS: New-onset reduction of the LVEF is common in advanced-age patients with NSTEMI and is associated with higher mortality. Treatment with guideline-recommended medications is associated with a better prognosis.
OBJECTIVES: We sought to investigate the association between LVEF and clinical outcomes after NSTEMI, and the benefit of guideline-recommended pharmacotherapy in elderly patients. BACKGROUND: New-onset reduction in LVEF is common after NSTEMI in patients of advanced age. There is little information about outcomes in relation to LVEF, and the benefit of guideline-recommended pharmacotherapy in elderly patients. MATERIALS AND METHODS: The SWEDEHEART registry was used to identify all patients in Sweden >80 years with NSTEMI from 2011 to 2014. A normal LVEF was defined as >50%; mildly reduced, 40%-49%; moderately reduced, 30%-39%; and severely reduced, <30%. Cox regression was used to calculate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for the association between a reduced LVEF compared with a normal LVEF and all-cause mortality. Similarly, the presence versus absence of treatment with guideline-recommended medications at discharge and mortality was evaluated. RESULTS: 6287 patients were included where 59%, 20%, 13%, and 6% had a normal, mildly reduced, moderately reduced, and severely reduced LVEF, respectively. During a median follow-up of 2.4 years, 2211 (35%) patients died. All three categories of impaired LVEF were associated with higher mortality: mildly reduced (1.44, 1.25-1.65), moderately reduced (1.93, 1.67-2.23), and severely reduced (3.24, 2.74-3.85). Patients who were treated with beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, or statins at discharge had lower mortality. CONCLUSIONS: New-onset reduction of the LVEF is common in advanced-age patients with NSTEMI and is associated with higher mortality. Treatment with guideline-recommended medications is associated with a better prognosis.
Authors: Osman Can Yontar; Guney Erdogan; Mustafa Yenercag; Sefa Gul; Ugur Arslan; Ali Karagoz Journal: Acta Cardiol Sin Date: 2021-11 Impact factor: 2.672
Authors: Meng-Meng Han; Wen-Shu Zhao; Xin Wang; Shan He; Xiao-Rong Xu; Cai-Jing Dang; Juan Zhang; Jia-Mei Liu; Mu-Lei Chen; Lin Xu; Hua Wang Journal: Int J Gen Med Date: 2021-06-03