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Left ventricular systolic dysfunction, total mortality, and sudden death in patients with myocardial infarction treated with n‐3 polyunsaturated fatty acids
Author(s) -
Macchia Alejandro,
Levantesi Giacomo,
Franzosi Maria Grazia,
Geraci Enrico,
Maggioni Aldo Pietro,
Marfisi RosaMaria,
Nicolosi Gian Luigi,
Schweiger Carlo,
Tavazzi Luigi,
Togi Gianni,
Valagussa Franco,
Marchioli Roberto
Publication year - 2005
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2005.04.008
Subject(s) - medicine , polyunsaturated fatty acid , cardiology , ejection fraction , myocardial infarction , heart failure , proportional hazards model , relative risk , fatty acid , confidence interval , chemistry , organic chemistry
Background Sudden death (SD) has a major impact on mortality (M) in patients with left ventricular systolic dysfunction (SyD). In GISSI‐Prevenzione, treatment with n‐3 polyunsaturated fatty acids (PUFA) reduced M and SD in post‐MI patients, but their effect in patients with SyD is unknown. Methods 11,323 patients with prior MI and NYHA class≤II were recruited. After excluding patients with no ejection fraction (EF) measurement (1684), and those with missing data ( n =9), 9630 patients were available for analysis. Multivariate Cox regression adjusted models were fitted. Results Compared to patients with EF>50%, SyD patients had higher M (12.3% vs. 6.0%) and SD (3.4% vs. 1.4%) rates. PUFA reduced M similarly in patients with (RR 0.76 (0.60–0.96) P =0.02) and without SyD (RR 0.81 (0.59–1.10) P =0.17) (heterogeneity tests P =0.55). In contrast, the effect on SD was markedly asymmetrical: PUFA produced a marked reduction (RR 0.42 (0.26–0.67) P =0.0003) of risk in SyD patients whereas the effect was less evident (RR 0.89 (0.41–1.69) P =0.71) in patients with EF>50% (heterogeneity tests P =0.07). There was a significant increase in SD with worsening EF ( P test for trend=0.02), the benefit on SD in patients with EF≤40% being 4‐fold higher than in those with EF>50%. Conclusions Increasing SyD is associated with elevated risk of SD and with increasing benefit from PUFA. The effect of PUFA on SD reduction was greater in patients with SyD. Prospective trials testing the effect of PUFA in populations with SyD are required.