Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction

Impairment of left ventricular function is the major predictor of mortality after acute myocardial infarction, but it is not known whether this is best described by ejection fraction or by end-systolic or end-diastolic volume. We measured volumes, ejection fractions, and severity of coronary arteria...

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Bibliographic Details
Published in:Circulation (New York, N.Y.) N.Y.), 1987-07, Vol.76 (1), p.44-51
Main Authors: WHITE, H. D, NORRIS, R. M, BROWN, M. A, BRANDT, P. W. T, WHITLOCK, R. M. L, WILD, C. J
Format: Article
Language:English
Subjects:
Biological and medical sciences
Blood Volume
Cardiac Surgical Procedures
Cardiology. Vascular system
Coronary heart disease
Heart
Heart - physiopathology
Humans
Male
Medical sciences
Middle Aged
Myocardial Infarction - mortality
Myocardial Infarction - physiopathology
Myocardial Infarction - therapy
Prognosis
Stroke Volume
Systole
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Summary:Impairment of left ventricular function is the major predictor of mortality after acute myocardial infarction, but it is not known whether this is best described by ejection fraction or by end-systolic or end-diastolic volume. We measured volumes, ejection fractions, and severity of coronary arterial occlusions and stenoses in 605 male patients under 60 years of age at 1 to 2 months after a first (n = 443) or recurrent (n = 162) myocardial infarction and followed these patients for a mean of 78 months for survivors (range 15 to 165 months). There were 101 cardiac deaths, 71 (70%) of which were sudden (instantaneous or found dead). Multivariate analysis with log rank testing and the Cox proportional hazards model showed that end-systolic volume (chi 2 = 82.9) had greater predictive value for survival than end-diastolic volume (chi 2 = 59.0) or ejection fraction (chi 2 = 46.6), whereas stepwise analysis showed that once the relationship between survival and end-systolic volume had been fitted, there was no additional significant predictive information in either end-diastolic volume or ejection fraction. Severity of coronary occlusions and stenoses showed additional prediction of only borderline significance (p = .04 in one analysis), but continued cigarette smoking did remain an independent risk factor after stepwise analysis. For a subset of patients (n = 200) who had taken part in a randomized trial of coronary artery surgery after recovery from infarction, surgical "intention to treat" showed no predictive value.
ISSN:0009-7322
1524-4539
DOI:10.1161/01.cir.76.1.44