Limitations of Ejection Fraction for Prediction of Sudden Death Risk in Patients With Coronary Artery Disease
Open accessAbstract
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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In the modern era, the independent predictive value of NSVT in MI survivors is not established.
“in the modern era, the independent predictive value of NSVT is not established”
From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Buxton et al., 2007
The Methods (p. 1151) say NSVT was required for entry into the MUSTT study, so this analysis could not compare MI survivors with and without NSVT to assess its independent predictive value. The Results examine characteristics and timing of NSVT, but no passage found states whether the independent predictive value of NSVT in modern-era MI survivors is established. (LLM, conf=0.73)
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- Authors
- Buxton, A. E., Lee, K. L., Hafley, G. E., Pires, L. A., Fisher, J. D., Gold, M. R., Josephson, M. E., Lehmann, M. H., & Prystowsky, E. N.
- Affiliations
- Brown University (US)
- Duke Medical Center (US)
- Albert Einstein College of Medicine (US)
- Medical University of South Carolina (US)
- Beth Israel Deaconess Medical Center (US)
- University of Michigan (US)
- Corresponding author
- Buxton, Alfred E.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2007-09
- Volume
- 50
- Issue
- 12
- Pages
- 1150-1157
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W29926391
- Cited by
- 356
- References
- 25
- Citations by year
- 2026: 7 · 2025: 2 · 2024: 4 · 2023: 9 · 2022: 9 · 2021: 11 · 2020: 11 · 2019: 16 · 2018: 24 · 2017: 27 · 2016: 24 · 2015: 28 · 2014: 23 · 2013: 40 · 2012: 21
- FWCI
- 17.79
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5u01hl045726-06)
- National Heart, Lung, and Blood Institute (UO1HL45700, UO1-HL45726, HL45700, U01HL045700)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- ejection fraction, sudden cardiac death, arrhythmic death, coronary artery disease, left ventricular dysfunction, risk stratification, mortality prediction, non-sustained ventricular tachycardia, atrial fibrillation, heart failure
- MeSH terms
- Aged, Anti-Arrhythmia Agents, Cause of Death, Coronary Artery Disease, Female, Heart Arrest, Humans, Male, Middle Aged, Predictive Value of Tests, Probability, Sensitivity and Specificity, Stroke Volume, Confidence Intervals, Chi-Square Distribution, Proportional Hazards Models, Death, Sudden, Cardiac, Defibrillators, Implantable, Tachycardia, Ventricular, Risk Assessment
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