Appropriate time for ejection fraction reassessment after revascularization in patients with left ventricular dysfunction for risk stratification of sudden cardiac death

Abstract

AbstractBackgroundAppropriate time for ejection fraction (EF) reassessment after revascularization in patients with left ventricular dysfunction has not been investigated comprehensively, although 3 months after revascularization is recommended to stratify the risk of sudden cardiac death (SCD).HypothesisEF reassessed within different timeframe after revascularization may have incosistent contribution for risk stratification of SCD.MethodsPatients who had EF ≤ 40% before revascularization and had EF reassessment at least once during follow‐up were included. The role of early (<3 months) versus late (3–12 months) EF measurements in prediction of all‐cause mortality and SCD were compared.ResultsA total of 1589 patients were identified. EF reassessed <3 months was lower than EF reassessed within 3–12 months (42.1 ± 9.7% vs. 45.8 ± 10.8%; p < .01). Among 1069 patients who had EF reassessed <3 months, EF ≤ 35% was associated with a higher risk of all‐cause mortality (hazard ratio [HR], 1.67; 95% confidence interval [CI], 1.22–2.29; p < .01), but had no association with the risk of SCD (HR, 1.44; 95% CI, 0.84–2.48; p = .18). By contrast, among 595 patients who had EF reassessed within 3–12 months, EF ≤ 35% was associated with higher risks of both all‐cause death (HR, 1.81; 95% CI, 1.06–3.10; p = .03) and SCD (HR, 2.71; 95% CI, 1.31–5.61; p < .01). The relative contribution of SCD to all‐cause death was higher in patients with EF ≤ 35% than patients with EF > 35% when EF was reassessed within 3–12 months (p = .04). However, when EF was reassessed <3 months, the mode of death was similar in patients with EF ≤ 35% versus >35% (p = .85).Conclusions3 to 12 months after revascularization may be appropriate for cardiac function reassessment and SCD risk stratification.