Cardiovascular risk factors profile in patients with acute coronary syndrome with particular reference to left ventricular ejection fraction.

BACKGROUND

Acute coronary syndrome (ACS) remains a leading cause of death in the United States. Numerous studies have shown that the degree of LV systolic dysfunction is a major if not the most important determinant of long-term outcome in ACS.

OBJECTIVES

To identify the most important risk factors and other clinical predictors which might have impact on left ventricular ejection fraction in patients with ACS.

RESULTS

The total patients (299) admitted to our center from July, 2015 till December, 2015; with established diagnosis of ACS were classified in to two groups: Group I: 193 patients with impaired LVEF <40% (64.5%), Group II: 106 patients with LVEF equal or >40% (35.5%). The patients of group I were significant elderly compared to those of group II (60.9±11.2 vs 56.9±10.6; p=0.002), had significant history of DM and CKD (66.3% and 31.1% VS 49.1% and 19.8%; p=0.004 and 0.036 respectively), presented mainly with STEMI- ACS (51.3% VS 28.3% respectively; p<0.001) with +v cardiac biomarker (troponin) (90.2% VS 66.0%; p<0.001). Moreover, patients of group I had more significant ischemic MR compared to the patients of group II (24.9% VS 3.8% respectively; p<0.001) with higher rate of LV thrombus discovered by echocardiography (25.4% VS 1.9%; p<0.001). Extensive significant CAD disease was observed to be higher among patients of group I (69.4% VS 57.5%; p=0.039) and those patients treated mainly with PCI revascularization therapy (68.9% VS 52.8%; p=0.002) compared to patients of group II who mainly treated medically (34.9% VS 17.6 %; p<0.001). Multiple logistic regression analysis demonstrated that DM (odd ratio (OR): 2.64, 95% confidence interval (CI): 1.45-4.79, P=0.01), presence of significant ischemic MR (OR: 13.7, 95% CI:2.84-66.1, p=0.001)and presence of significantly diseased coronary vessels (odd ratio (OR): 5.06, 95% confidence interval (CI): 1.14-22.6, P=0.033,) all were independent predictors for significant LV dysfunction (LVEF <40%) which predict poor outcome in ACS patients.

CONCLUSION

We concluded that DM, presence of significant ischemic MR, and increased number, severity of diseased coronaries all were independent predictors of LV dysfunction (LVEF <40%) which is known to predict poor outcome. Identification of those risk predictors upon patient evaluation could be helpful to identify high risk-patients, in need of particular care, aggressive therapy and close follow-up to improve their poor outcome.