Left ventricular systolic dysfunction, total mortality, and sudden death in patients with myocardial infarction treated with n-3 polyunsaturated fatty acids

Alejandro Macchia, Giacomo Levantesi, Maria Grazia Franzosi, Enrico Geraci, Aldo Pietro Maggioni, RosaMaria Marfisi, Gian Luigi Nicolosi, Carlo Schweiger, Luigi Tavazzi, Gianni Tognoni, Franco Valagussa, Roberto Marchioli

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Sudden death (SD) has a major impact on mortality (M) in patients with left ventricular systolic dysfunction (SyD). In GISSI-Prevenzione, treatment with n-3 polyunsaturated fatty acids (PUFA) reduced M and SD in post-MI patients, but their effect in patients with SyD is unknown. Methods: 11,323 patients with prior MI and NYHA class ≤ II were recruited. After excluding patients with no ejection fraction (EF) measurement (1684), and those with missing data (n = 9), 9630 patients were available for analysis. Multivariate Cox regression adjusted models were fitted. Results: Compared to patients with EF > 50%, SyD patients had higher M (12.3% vs. 6.0%) and SD (3.4% vs. 1.4%) rates. PUFA reduced M similarly in patients with (RR 0.76 (0.60-0.96) P = 0.02) and without SyD (RR 0.81 (0.59-1.10) P = 0.17) (heterogeneity tests P = 0.55). In contrast, the effect on SD was markedly asymmetrical: PUFA produced a marked reduction (RR 0.42 (0.26-0.67) P = 0.0003) of risk in SyD patients whereas the effect was less evident (RR 0.89 (0.41-1.69) P = 0.71) in patients with EF > 50% (heterogeneity tests P = 0.07). There was a significant increase in SD with worsening EF (P test for trend = 0.02), the benefit on SD in patients with EF ≤ 40% being 4-fold higher than in those with EF > 50%. Conclusions: Increasing SyD is associated with elevated risk of SD and with increasing benefit from PUFA. The effect of PUFA on SD reduction was greater in patients with SyD. Prospective trials testing the effect of PUFA in populations with SyD are required.

Original languageEnglish
Pages (from-to)904-909
Number of pages6
JournalEuropean Journal of Heart Failure
Volume7
Issue number5
DOIs
Publication statusPublished - Aug 2005

Keywords

  • Fatty acids
  • Left ventricular systolic dysfunction
  • Sudden death
  • Unsaturated

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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