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The significance of electrocardiographically determined left ventricular hypertrophy (LVH) in STEMI pts in the percutaneous coronary intervention era is unclear.
In the HORIZONS–AMI trial, 3,602 STEMI pts were randomized to receive unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor or bivalirudin. Endpoints included MACE (death, reinfarction, target vessel revascularization or stroke) and its components. We analyzed outcomes according to the presence or absence of electrographically determined LVH.
3,305 pts had baseline electrocardiograms that were analyzed at a core laboratory; LVH was present in 111 patients. LVH pts had higher rates of co–morbid conditions. Primary PCI was more likely to be performed after angiography in pts without LVH (93.4% vs. 78.4%, p<0.0001). Pts with LVH had higher rates of 30–day cardiac mortality (5.4% vs. 2.2%, p=0.02) and stroke (2.8% vs. 0.6%, p=0.008). At 1 year, LVH pts had higher rates of all–cause mortality and stroke. Furthermore, LVH was an independent predictor of 1–year mortality or stroke (HR [CI] = 1.99 [1.04, 3.80]; p=0.04).
LVH by electrocardiography identifies a STEMI pt subset with increased mortality and stroke rates.
|1-year Events||LVH (n=111)||No LVH (n=3194)||P value|
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Acute Coronary Syndrome and Acute Myocardial Infarction
Abstract Category: 40. TCT@ACC–i2: ACS/AMI/Hemodynamic Support
Presentation Number: 2113–262
- 2013 American College of Cardiology Foundation