Author + information
- Received January 23, 2007
- Revision received April 17, 2007
- Accepted April 23, 2007
- Published online September 18, 2007.
- Alfred E. Buxton, MD, FACC⁎,⁎ (, )
- Kerry L. Lee, PhD†,
- Gail E. Hafley, MS†,
- Luis A. Pires, MD‡,
- John D. Fisher, MD§,
- Michael R. Gold, MD∥,
- Mark E. Josephson, MD#,
- Michael H. Lehmann, MD⁎⁎,
- Eric N. Prystowsky, MD††,
- MUSTT Investigators
- ↵⁎Reprint requests and correspondence:
Dr. Alfred E. Buxton, Cardiology Division, Brown Medical School, 2 Dudley Street, Suite 360, Providence, Rhode Island 02905.
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 ≤30% have a predicted 2-year arrhythmic death risk <5%.
Conclusions Multiple variables influence arrhythmic death and total mortality risk. Patients with EF ≤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 ≤30%. Thus, risk of sudden death in patients with coronary disease depends on multiple variables in addition to EF.
Supported by grants UO1 HL45700 and UO1 HL45726 from the National Heart, Lung, and Blood Institute, National Institutes of Health, and by grants from C.R. Bard, Berlex Laboratories, Boehringer-Ingelheim Pharmaceuticals, Cardiac Pacemakers/Guidant, Knoll Pharmaceutical Co., Medtronic, Searle Pharmaceutical, Ventritex, and Wyeth-Ayerst Laboratories.
- Received January 23, 2007.
- Revision received April 17, 2007.
- Accepted April 23, 2007.
- American College of Cardiology Foundation