Cited by 356Cardiac electrophysiology and arrhythmiasCardiac pacing and defibrillation studiesCardiac Health and Mental Health

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Limitations of Ejection Fraction for Prediction of Sudden Death Risk in Patients With Coronary Artery Disease

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Buxton, Alfred E., Lee, Kerry L., Hafley, Gail E., Pires, Luis A., Fisher, John D., Gold, Michael R., Josephson, Mark E., Lehmann, Michael H., Prystowsky, Eric N.·2007·Journal of the American College of Cardiology

DOI 10.1016/j.jacc.2007.04.095

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Abstract

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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BackgroundMethodInfluential
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Background
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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: Buxton, Alfred E.
Lee, Kerry L.
Fisher, John D.
Gold, Michael R.
Lehmann, Michael H.
Prystowsky, Eric N.
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)
DOI: 10.1016/j.jacc.2007.04.095
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: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 2145 d)
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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Limitations of Ejection Fraction for Prediction of Sudden Death Risk in Patients With Coronary Artery Disease

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