Low ejection fraction documented during cardiac catheterization is significantly associated with long-term, all-cause mortality

Background: Decreased ejection fraction (EF) has been found to be a strong predictor of mortality. However, this association has not been studied in patients undergoing ventriculography over a long period of time. Using a large database of patients who underwent coronary angiography for clinical reasons, we evaluated any association between severity of EF impairment and 10 year mortality. Methods: Retrospective angiographic data of 1,937 patients between 1993 to 1997 from the VA Long Beach Health Care System were studied. Decreased EF was defined as EF<50%. Using chi-square test and Cox survival analysis, we evaluated any association between decreased EF with mortality. Furthermore, we evaluated different degrees of decreased EF with all-cause mortality using uni- and multivariate analysis. Results: Total mortality was 22.9% of the cohort. Decreased EF was a strong predictor of death over a period of 10 years. (All-cause mortality occurred in 21.6 % of patients with normal EF vs. 41.7 %, OR 2.59, CI 2.06-3.26, P<.001). After adjustment for left main coronary artery disease, mitral regurgitation, three-vessel coronary disease, and clinical risk factors (diabetes, hypertension, hyperlipidemia, and smoking), decreased EF remained independently associated with all cause-mortality regardless of ethnicity. Conclusion: Decreased EF measured during coronary angiography is a strong independent predictor of all-cause mortality over a period of 10 years.