Original Investigation
Predicting Persistent Left Ventricular Dysfunction Following Myocardial Infarction: The PREDICTS Study

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Abstract

Background

Persistent severe left ventricular (LV) systolic dysfunction after myocardial infarction (MI) is associated with increased mortality and is a class I indication for implantation of a cardioverter-defibrillator.

Objectives

This study developed models and assessed independent predictors of LV recovery to >35% and ≥50% after 90-day follow-up in patients presenting with acute MI and severe LV dysfunction.

Methods

Our multicenter prospective observational study enrolled participants with ejection fraction (EF) of ≤35% at the time of MI (n = 231). Predictors for EF recovery to >35% and ≥50% were identified after multivariate modeling and validated in a separate cohort (n = 236).

Results

In the PREDICTS (PREDiction of ICd Treatment Study) study, 43% of patients had persistent EF ≤35%, 31% had an EF of 36% to 49%, and 26% had an EF ≥50%. The model that best predicted recovery of EF to >35% included EF at presentation, length of stay, prior MI, lateral wall motion abnormality at presentation, and peak troponin. The model that best predicted recovery of EF to ≥50% included EF at presentation, peak troponin, prior MI, and presentation with ventricular fibrillation or cardiac arrest. After predictors were transformed into point scores, the lowest point scores predicted a 9% and 4% probability of EF recovery to >35% and ≥50%, respectively, whereas profiles with the highest point scores predicted an 87% and 49% probability of EF recovery to >35% and ≥50%, respectively.

Conclusions

In patients with severe systolic dysfunction following acute MI with an EF ≤35%, 57% had EF recovery to >35%. A model using clinical variables present at the time of MI can help predict EF recovery.

Key Words

heart failure
remodeling
risk assessment
ventricular ejection fraction

Abbreviations and Acronyms

ACEI
angiotensin-converting enzyme inhibitor
ARB
angiotensin receptor blocker
BNP
B-type natriuretic peptide
CABG
coronary artery bypass graft
CI
confidence interval
EF
ejection fraction
HF
heart failure
ICD
implantable cardioverter-defibrillator
LV
left ventricular
MI
myocardial infarction
OR
odds ratio
PCI
percutaneous coronary intervention
ULN
upper limit of normal
VF
ventricular fibrillation

Cited by (0)

The study was supported by grants from the National Institutes of Health/National Heart, Lung, and Blood Institute (NIH/NHLBI) to Dr. Olgin (U01-HL089458) and Dr. Pletcher (U01-HL089145), as well as from Medtronic and ZOLL Medical Corporation. Dr. Morin has served on the speakers bureau for Medtronic Inc., Biotronik, and Zoll; and has received research grant support from Medtronic and Boston Scientific. Dr. Zweibel has served as a consultant for and speaker for Medtronic Inc. Dr. Buxton has received research grant support from Medtronic and Biosense-Webster. Dr. Olgin has received grant support from Zoll and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Listen to this manuscript's audio summary by JACC Editor-in-Chief Dr. Valentin Fuster.