Skip to main content
construction release_alert
Scholars@Duke will be undergoing maintenance April 11-15. Some features may be unavailable during this time.
cancel
Journal cover image

Predicting chronic left ventricular dysfunction 90 days after ST-segment elevation myocardial infarction: An Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) Substudy.

Publication ,  Journal Article
Ezekowitz, JA; Armstrong, PW; Granger, CB; Theroux, P; Stebbins, A; Kim, RJ; Patel, MR
Published in: Am Heart J
August 2010

OBJECTIVES: The purpose of this study was to determine predictors of 90-day left ventricular function following acute ST-segment elevation myocardial infarction (STEMI) using variables from clinical presentation, biomarker testing, and cardiovascular magnetic resonance imaging (CMR). BACKGROUND: Identifying patients with acute STEMI who experience adverse remodeling and develop left ventricular dysfunction 3 months post-MI is a priority for guiding subsequent therapy. METHODS: The Assessment of Pexelizumab in Acute Myocardial Infarction trial tested pexelizumab treatment in STEMI patients presenting within 6 hours of symptom onset who were to undergo primary percutaneous coronary intervention. We studied 64 patients within this trial according to a prespecified substudy that included paired core laboratory delayed-enhancement CMR at days 3 and 90 as well as plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP; in picograms per milliliter) measured at randomization and 24 hours. A multivariable model predicting day 90 left ventricular ejection fraction (LVEF) was developed from clinical, biomarker, and imaging findings. RESULTS: Patients had a median age of 60 years (52-68), 89% were male, and 60% had anterior STEMI. Time from symptom onset to percutaneous coronary intervention was 3 hours. The median baseline LVEF was 48% (38%-56%) and was 50% (40%-54%) at 90 days: 7 patients (11%) had an LVEF <35% at 90 days. Patients with a lower 90-day LVEF (as a continuous variable) had a higher 24-hour NT-proBNP (P = .02) and a larger baseline infarct size by CMR (median 15% LV [8%-20% LV]) (P < .01). Microvascular obstruction (no reflow) was greater as measured by CMR (median 2.8% [1.4%-6.1%]) in patients with a lower 90-day LVEF (P < .01). Median baseline and 24-hour NT-proBNP levels were 94 pg/mL (54-292 pg/mL) and 1,448 pg/mL (958-2,599 pg/mL), respectively. In a multivariable model with clinical, biomarker, and imaging variables, only 3 variables independently predicted 90-day LVEF: 24-hour NT-proBNP, baseline CMR infarct size, and microvascular obstruction. CONCLUSIONS: Three key pathophysiologic variables of the post-STEMI myocardium measuring baseline infarct size and the extent of microvascular obstruction on CMR and wall tension (24-hour NT-proBNP) independently predicted 90-day LVEF. Further studies linking these measures with earlier use of clinical therapies may be warranted.

Duke Scholars

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

August 2010

Volume

160

Issue

2

Start / End Page

272 / 278

Location

United States

Related Subject Headings

  • Ventricular Remodeling
  • Ventricular Dysfunction, Left
  • Stroke Volume
  • Single-Chain Antibodies
  • Risk Assessment
  • Protein Precursors
  • Peptide Fragments
  • Natriuretic Peptide, Brain
  • Myocardial Infarction
  • Middle Aged
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Ezekowitz, J. A., Armstrong, P. W., Granger, C. B., Theroux, P., Stebbins, A., Kim, R. J., & Patel, M. R. (2010). Predicting chronic left ventricular dysfunction 90 days after ST-segment elevation myocardial infarction: An Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) Substudy. Am Heart J, 160(2), 272–278. https://doi.org/10.1016/j.ahj.2010.05.035
Ezekowitz, Justin A., Paul W. Armstrong, Christopher B. Granger, Pierre Theroux, Amanda Stebbins, Raymond J. Kim, and Manesh R. Patel. “Predicting chronic left ventricular dysfunction 90 days after ST-segment elevation myocardial infarction: An Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) Substudy.Am Heart J 160, no. 2 (August 2010): 272–78. https://doi.org/10.1016/j.ahj.2010.05.035.
Ezekowitz, Justin A., et al. “Predicting chronic left ventricular dysfunction 90 days after ST-segment elevation myocardial infarction: An Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) Substudy.Am Heart J, vol. 160, no. 2, Aug. 2010, pp. 272–78. Pubmed, doi:10.1016/j.ahj.2010.05.035.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

August 2010

Volume

160

Issue

2

Start / End Page

272 / 278

Location

United States

Related Subject Headings

  • Ventricular Remodeling
  • Ventricular Dysfunction, Left
  • Stroke Volume
  • Single-Chain Antibodies
  • Risk Assessment
  • Protein Precursors
  • Peptide Fragments
  • Natriuretic Peptide, Brain
  • Myocardial Infarction
  • Middle Aged