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In Reply: Dr Palmerini and colleagues highlight the importance of LVEF as a prognostic factor. Systematic LVEF measures were not part of the APEX-AMI protocol and thus were unavailable in many patients. Moreover, when assessing risk at the time of presentation or at the time of the primary PCI procedure, LVEF is frequently not available. Many other risk models do not include LVEF.^1-2 This does not mean that these models are less useful than those including LVEF, nor do they preclude the prognostic importance of LVEF. Rather, this suggests that accurate risk prediction is possible even in the absence of LVEF—a variable not collected for a large number of STEMI patients globally. Conversely, some risk prediction models that included LVEF as a variable did not include some of the variables in our model, most notably sustained VT/VF.^3-4

Because of large amounts of missing data on LVEF, we believed it was . . . [Full Text of this Article]

Rajendra H. Mehta, MD, MS
mehta007@dcri.duke.edu
Duke Clinical Research Institute
Durham, North Carolina

Paul W. Armstrong, MD
University of Alberta
Edmonton, Alberta, Canada

Christopher B. Granger, MD
Duke Clinical Research Institute

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