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Limitations of ejection fraction for prediction of sudden death risk in patients with coronary artery disease: lessons from the MUSTT study.

Publication ,  Journal Article
Buxton, AE; Lee, KL; Hafley, GE; Pires, LA; Fisher, JD; Gold, MR; Josephson, ME; Lehmann, MH; Prystowsky, EN; MUSTT Investigators,
Published in: J Am Coll Cardiol
September 18, 2007

OBJECTIVES: We determined the contribution of multiple variables to predict arrhythmic death and total mortality risk in patients with coronary disease and left ventricular dysfunction. We then constructed an algorithm to predict risk of mortality and sudden death. BACKGROUND: Many factors in addition to ejection fraction (EF) influence the prognosis of patients with coronary disease. However, there are few tools to use this information to guide clinical decisions. METHODS: We evaluated the relationship between 25 variables and total mortality and arrhythmic death in 674 patients enrolled in the MUSTT (Multicenter Unsustained Tachycardia Trial) study that did not receive antiarrhythmic therapy. We then constructed risk-stratification algorithms to weight the prognostic impact of each variable on arrhythmic death and total mortality risk. RESULTS: The variables having the greatest prognostic impact in multivariable analysis were functional class, history of heart failure, nonsustained ventricular tachycardia not related to bypass surgery, EF, age, left ventricular conduction abnormalities, inducible sustained ventricular tachycardia, enrollment as an inpatient, and atrial fibrillation. The model demonstrates that patients whose only risk factor is EF < or =30% have a predicted 2-year arrhythmic death risk <5%. CONCLUSIONS: Multiple variables influence arrhythmic death and total mortality risk. Patients with EF < or =30% but no other risk factor have low predicted mortality risk. Patients with EF >30% and other risk factors may have higher mortality and a higher risk of sudden death than some patients with EF < or =30%. Thus, risk of sudden death in patients with coronary disease depends on multiple variables in addition to EF.

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

September 18, 2007

Volume

50

Issue

12

Start / End Page

1150 / 1157

Location

United States

Related Subject Headings

  • Tachycardia, Ventricular
  • Stroke Volume
  • Sensitivity and Specificity
  • Risk Assessment
  • Proportional Hazards Models
  • Probability
  • Predictive Value of Tests
  • Middle Aged
  • Male
  • Humans
 

Citation

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Buxton, A. E., Lee, K. L., Hafley, G. E., Pires, L. A., Fisher, J. D., Gold, M. R., … MUSTT Investigators, . (2007). Limitations of ejection fraction for prediction of sudden death risk in patients with coronary artery disease: lessons from the MUSTT study. J Am Coll Cardiol, 50(12), 1150–1157. https://doi.org/10.1016/j.jacc.2007.04.095
Buxton, Alfred E., Kerry L. Lee, Gail E. Hafley, Luis A. Pires, John D. Fisher, Michael R. Gold, Mark E. Josephson, Michael H. Lehmann, Eric N. Prystowsky, and Eric N. MUSTT Investigators. “Limitations of ejection fraction for prediction of sudden death risk in patients with coronary artery disease: lessons from the MUSTT study.J Am Coll Cardiol 50, no. 12 (September 18, 2007): 1150–57. https://doi.org/10.1016/j.jacc.2007.04.095.
Buxton AE, Lee KL, Hafley GE, Pires LA, Fisher JD, Gold MR, et al. Limitations of ejection fraction for prediction of sudden death risk in patients with coronary artery disease: lessons from the MUSTT study. J Am Coll Cardiol. 2007 Sep 18;50(12):1150–7.
Buxton, Alfred E., et al. “Limitations of ejection fraction for prediction of sudden death risk in patients with coronary artery disease: lessons from the MUSTT study.J Am Coll Cardiol, vol. 50, no. 12, Sept. 2007, pp. 1150–57. Pubmed, doi:10.1016/j.jacc.2007.04.095.
Buxton AE, Lee KL, Hafley GE, Pires LA, Fisher JD, Gold MR, Josephson ME, Lehmann MH, Prystowsky EN, MUSTT Investigators. Limitations of ejection fraction for prediction of sudden death risk in patients with coronary artery disease: lessons from the MUSTT study. J Am Coll Cardiol. 2007 Sep 18;50(12):1150–1157.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

September 18, 2007

Volume

50

Issue

12

Start / End Page

1150 / 1157

Location

United States

Related Subject Headings

  • Tachycardia, Ventricular
  • Stroke Volume
  • Sensitivity and Specificity
  • Risk Assessment
  • Proportional Hazards Models
  • Probability
  • Predictive Value of Tests
  • Middle Aged
  • Male
  • Humans