Introduction: Identifying risk factors for specific types of death in patients with HF or LV dysfunction after AMI may potentially reduce events. Low EF is associated with increased rates of death, but its ability to forecast specific causes of death remains unclear.
Hypothesis: Lower LVEF categories are associated with increases in sudden death, HF death, other CV death, and non CV death.
Methods: In an individual patient data meta-analysis of four merged large randomized trials (CAPRICORN, EPHESUS, OPTIMAAL, and VALIANT), Cox proportional hazards modeling was performed to study the association between LVEF at baseline and modes of death during follow-up. All the cause-specific deaths were adjudicated by independent committees.
Results: Three trials sampled LVEF as part of study protocol resulting in 19740 eligible patients (OPTIMAAL excluded). Over a median follow-up of 707 days, a total of 3419 deaths occurred. The distribution pattern of specific death causes (figure 1) was similar across LVEF categories (<25%, 25-35%, >35%). In multivariable models adjusted for age, sex, Killip class, systolic BP, diabetes, hypertension, renal failure, COPD, peripheral artery disease, medication use (beta-blockers, ACE inhibitors/ARB, diuretics), eGFR, Hb and sodium, the risk of all types of death increased with decreasing LVEF. Each 5% decrease in LVEF was associated with a 23% increased risk of sudden death (HR 1.23, 95% CI 1.14-1.33), a 26% increased risk of HF death (HR 1.26, 95% CI 1.15-1.39), a 13% increased risk of other CV death (HR 1.13, 95% CI 1.04-1.24), and a 14% increased risk of non CV death (HR 1.14, 95% CI 1.00-1.29).
Conclusions: In patients with HF or LV dysfunction after MI, low LVEF is an ubiquitous risk marker associated with death regardless of type. It consequently deserves great attention beyond the risk of sudden death and may be a marker not just specific to sudden death. Mode of death is equally represented throughout the categories of increasingly compromised LVEF.