Author + information
- Received October 25, 1994
- Revision received February 24, 1995
- Accepted March 2, 1995
- Published online July 1, 1995.
- Barry L. Zaret, MD, FACCa,*,
- Frans J.Th. Wackers, MD, FACCa,
- Michael L. Terrin, MD, MPHa,*,
- Sandra A. Forman, MAa,*,
- David O. Williams, MD, FACCa,†,
- Genell L. Knatterud, PhDa,*,
- Eugene Braunwald, MD, FACCa,‡,a,
- for the TIMI Study Group
- ↵*Address for correspondence: Dr. Barry L. Zaret. Chief, Cardiovascular Medicine, Department of Internal Medicine, Yale University. 333 Cedar Street, New Haven, Connecticut 06520-8017.
Objectives. This study sought to determine the prognostic value of rest and exercise left ventricular ejection fraction in patients receiving thrombolytic therapy as part of the Thrombolysis in Myocardial Infarction (TIMI) trial.
Background. In the prethrombolytic era, ejection fraction at rest as well as during exercise was an important prognostic index in patients recovering from acute myocardial infarction. The prognostic value of these measurements in the thrombolytic era is not clear.
Methods. As part of the TIMI II protocol, we obtained radio-nuclide left ventricular ejection fraction at rest and during symptom-limited submaximal supine exercise. Measurements were related to 1-year all-cause as well as cardiac mortality. In addition, the relation between ejection fraction obtained at rest and 1-year cardiac mortality in this study was compared with the relation established previously in the prethrombolytic era by the Multicenter Postinfarction Research Group.
Results. A distinct relation was noted between left ventricular ejection fraction at rest and all-cause mortality. The highest mortality rate (9.9%) was noted in patients with an ejection fraction <30%. Those not undergoing a study had a 1-year mortality rate of 6.2%. Peak exercise ejection fraction provided prognostic information similar to that of rest ejection fraction. Likewise, change in ejection fraction from rest to exercise did not appreciably improve prognostic impact.
Conclusions. Rest left ventricular ejection fraction is an important prognostic index in patients receiving thrombolytic therapy. Peak exercise ejection fraction and the change in ejection fraction from rest to exercise do not provide appreciable prognostic data beyond those obtained at rest. Patients unable to exercise or those not having a rest study have a poor prognosis. When compared with the Multicenter Postinfarction Research Group data, there was strong evidence of a difference in survival in the two studies. At any level of ejection fraction, mortality was lower in TIMI II patients than in patients in the prethrombolytic era.
A complete list of TIMI co-investigators and participating institutions appears in reference 15. This study was supported by the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda. Maryland.
- Received October 25, 1994.
- Revision received February 24, 1995.
- Accepted March 2, 1995.
- The American College of Cardiology