Ejection fraction and long-term outcomes in patients with different renal function after acute coronary syndrome

Objective. To analyze ejection fraction depending on renal function and its relationship with long-term outcomes in patients with acute coronary syndrome. Material and methods. The study included 1.607 patients (mean age 63.8±12.1 years, 64.9% men) discharged between January 1, 2019, and December 31, 2020. All ones underwent treatment for ACS. The authors analyzed left ventricular ejection fraction (LVEF), all-cause and cardiovascular mortality in patients with CKD≥C3a and without significant renal impairment. The median follow-up was 42.3 [32.5; 48.4] months. Results. In patients with CKD≥C3a, EF increased only by 1.1% [-4.8; 11] (p=0.07) within a year, in patients with GFR>60 ml/min/1.73 m2 — by 7.1% [0.4; 14.1] (p<0.001). Among patients with GFR<60 ml/min/1.73 m2, there were no significant differences in the risk of death from all or cardiovascular causes regardless of EF. In patients with EF<50%, the risk of all-cause mortality in CKD was 5.2 times (95% CI 3.45—7.95) higher and cardiovascular mortality was 7.18 times (95% CI 4.03—12.74) higher than in patients with GFR>60 ml/min/1.73 m2. All-cause mortality rate in patients with preserved LVEF was 6.53 times (95% CI 2.94—14.51) higher and cardiovascular mortality rate was 6.91 times (95% CI 2.34—20.4) higher in patients with GFR<60 ml/min/1.73 m2 compared to GFR>60 ml/min/1.73 m2. Conclusion. In patients with CKD≥C3a, LVEF does not significantly increase within a year after ACS. All-cause and cardiovascular mortality rate in patients with CKD≥C3a and different LVEFs are comparable, whereas these values increase inversely proportional to EF decrease in patients without severe renal impairment.