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Additive prognostic value of left ventricular ejection fraction to the TIMI risk score for in-hospital and long-term mortality in patients with ST segment elevation myocardial infarction

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Abstract

To investigate whether the addition of left ventricular ejection fraction (LVEF) to the TIMI risk score enhances the prediction of in-hospital and long-term death in ST segment elevation myocardial infarction (STEMI) patients. 673 patients with STEMI were divided into three groups based on TIMI risk score for STEMI: low-risk group (TIMI ≤3, n = 213), moderate-risk group (TIMI 4–6, n = 285), and high-risk group (TIMI ≥7, n = 175). The predictive value was evaluated using the receiver operating characteristic. Multivariate logistic regression was used to determine risk predictors. The rates of in-hospital death (0.5 vs 3.2 vs 10.3 %, p < 0.001) and major adverse cardiovascular events (14.6 vs 22.5 vs 40.6 %, p < 0.001) were significantly higher in high-risk group. Multivariate analysis showed that TIMI risk score (OR 1.24, 95 % CI 1.04–1.48, P = 0.015) and LVEF (OR 3.85, 95 % CI 1.58–10.43, P = 0.004) were independent predictors of in-hospital death. LVEF had good predictive value for in-hospital death (AUC: 0.838 vs 0.803, p = 0.571) or 1-year death (AUC: 0.743 vs 0.728, p = 0.775), which was similar to TIMI risk score. When compared with the TIMI risk score alone, the addition of LVEF was associated with significant improvements in predicting in-hospital (AUC: 0.854 vs 0.803, p = 0.033) or 1-year death (AUC: 0.763 vs 0.728, p = 0.016). The addition of LVEF to TIMI risk score enhanced net reclassification improvement (0.864 for in-hospital death, p < 0.001; 0.510 for 1-year death, p < 0.001). LVEF was associated with in-hospital and long-term mortality in STEMI patients and had additive prognostic value to TIMI risk score.

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    Authors and Affiliations

    1. Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, 510100, China

      Xue-biao Wei, Yuan-hui Liu, Peng-cheng He, Lei Jiang, Ying-ling Zhou, Ji-yan Chen, Ning Tan & Dan-qing Yu

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    1. Xue-biao Wei
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    Xue-biao Wei and Yuan-hui Liu have contributed equally to this work.

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    Wei, Xb., Liu, Yh., He, Pc. et al. Additive prognostic value of left ventricular ejection fraction to the TIMI risk score for in-hospital and long-term mortality in patients with ST segment elevation myocardial infarction. J Thromb Thrombolysis 43, 1–6 (2017). https://doi.org/10.1007/s11239-016-1407-7

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