Graduado em Medicina pela Universidade Estadual de Montes Claros, residência Médica em Clínica Médica do Hospital das Clínicas da Faculdade de Medicina da Universidade São Paulo, residência em Cardiologia pelo Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da USP (2020), Fellowship/Subespecialização Unidade Clínica Coronariopatia Aguda (UCCA) do Instituto do Coração (InCor) do Hospital das Clínicas da FMUSP. Doutorando na pós-graduação em cardiologia da Universidade de São Paulo. Plantonista da UTI Cardiológica e Unidade Coronária do Hospital Sírio Libanês. Diarista da UTI cardiológica do Hospital Vila Nova Star e São Luiz Itaim.
RESEARCH, TEACHING, or OTHER INTERESTS
Medicine
1
Scopus Publications
Scopus Publications
Long-term mortality after acute coronary syndromes among patients with normal, mildly reduced, or reduced ejection fraction Remo H.M. Furtado, Marcela G. Juliasz, Felipe Y.J. Chiu, Livia B.C. Bastos, Talia F. Dalcoquio, et al. Esc Heart Failure, 2023 AimsLeft ventricular ejection fraction (LVEF) ≤ 40% is a well‐established risk factor for mortality after acute coronary syndromes (ACS). However, the long‐term prognostic impact of mildly reduced ejection fraction (EF) (LVEF 41–49%) after ACS remains less clear.Methods and resultsThis was a retrospective study enrolling patients admitted with ACS included in a single‐centre databank. LVEF was assessed by echocardiography during index hospitalization. Patients were divided in the following categories according to LVEF: normal (LVEF ≥ 50%), mildly reduced (LVEF 41–49%), and reduced (LVEF ≤ 40%). The endpoint of interest was all‐cause death after hospital discharge. A multivariable Cox model was used to adjust for confounders. A total of 3200 patients were included (1952 with normal EF, 375 with mildly reduced EF, and 873 with reduced EF). The estimated cumulative incidence rates of mortality at 10 years for patients with normal, mildly reduced, and reduced EF were 24.8%, 33.5%, and 41.3%, respectively. After adjustments, the presence of reduced EF was associated with higher mortality compared with normal EF [adjusted hazard ratio (HR) 1.64; 95% confidence interval (CI) 1.36–1.96; P < 0.001], as was mildly reduced EF compared with normal EF (adjusted HR 1.33; 95% CI 1.05–1.68; P = 0.019). The presence of reduced EF was not associated with a statistically significantly higher mortality compared with mildly reduced EF (adjusted HR 1.23; 95% CI 0.96–1.57; P = 0.095).ConclusionsIn patients with ACS, mildly reduced EF measured in the acute phase was associated with higher long‐term mortality compared with patients with normal EF. These data emphasize the importance of anti‐remodelling therapies for ACS patients who have LVEF in the mildly reduced range.
