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E/e' in relation to outcomes in ST‐elevation myocardial infarction
Author(s) -
Tai Sarah B,
Lau Wei Ren,
Gao Fei,
Hamid Nadira,
Amanullah Mohammed Rizwan,
Fam Jiang Ming,
Yap Jonathan,
Ewe See Hooi,
Chan Mark Y.,
Yeo Khung Keong,
Ding Zee Pin,
Sahlén Anders
Publication year - 2020
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.14652
Subject(s) - medicine , cardiology , myocardial infarction , ejection fraction , confidence interval , percutaneous coronary intervention , odds ratio , heart failure , diabetes mellitus , revascularization , stroke (engine) , proportional hazards model , endocrinology , mechanical engineering , engineering
Background Myocardial infarction (MI) is a high‐risk condition especially when filling pressure is raised, and earlier reports have suggested that E/e’ is associated with poor outcome. However, whether E/e’ predicts risk better than LVEF, which is the current standard of practice, is not known. We investigated this question in the largest and most rigorous study of MI patients so far. Methods and Results We studied 660 patients with ST‐elevation MI (STEMI) treated with primary percutaneous coronary intervention and related E/e’ to short‐term mortality (in‐hospital death), as well as long‐term events at 2 years comprising (a) a composite of MI, stroke, heart failure, and death, and (b) death alone. Short‐term models were adjusted for age, sex, and LVEF. Long‐term models were adjusted for age, sex, diabetes, revascularization procedure, history of MI, hypertension, renal function, drugs on discharge, and LVEF. Elevated E/e’> 15 indicated higher risk of short‐term events (n = 19:7.0% (95% confidence interval 3.4‐10.8%) vs. 1.0% (0.3 ‐ 2.3%); adjusted odds ratio 3.7 (1.3‐10.5)). While elevated E/e’ was also associated with long‐term outcomes (n = 103 composite events: 15.9% (11.9% – 21.4%) vs 6.8% (5.2% – 8.7%), P < .001; n = 38 death events: 6.0% (3.9% – 9.5%) vs 2.0% (1.3% – 3.2%), P = .001), E/e’ was rendered nonsignificant for long‐term outcomes by multivariable adjustment (p = ns for both). LVEF, on the contrary, was a highly significant predictor in the adjusted long‐term model. Conclusion E/e’ is associated with poor outcome in STEMI, but LVEF is a stronger predictor of long‐term risk.