Association between reduced left ventricular ejection fraction following non-ST-segment elevation myocardial infarction and long-term mortality in patients of advanced age

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.