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Published on: January 28, 2020
Predictors of improvement in left ventricular function after initially successful angioplasty of unprotected left
Fang-Bin Hu1, Hideo Tamai, Kunihiko Kosuga
1Department of Cardiology, Shiga Medical Center for Adults, Moriyama, Shiga, Japan.
Insights
Percutaneous coronary intervention (PCI) improves left ventricular ejection fraction (LVEF), particularly in patients with reduced baseline LVEF. This study identifies factors influencing LVEF changes after PCI for unprotected left main coronary artery lesions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Percutaneous coronary intervention (PCI) is increasingly used for unprotected left main coronary artery (LMCA) lesions.
- The impact of PCI on left ventricular (LV) performance remains incompletely understood.
- No studies have identified factors influencing left ventricular ejection fraction (LVEF) post-PCI in these patients.
Purpose of the Study:
- To evaluate the effect of PCI on LVEF in patients with unprotected LMCA lesions.
- To identify clinical and procedural factors associated with LVEF improvement after PCI.
Main Methods:
- A cohort of 199 patients undergoing de novo PCI for unprotected LMCA stenoses between April 1986 and August 2002.
- Clinical and angiographic follow-up, including paired left ventriculography for LVEF assessment.
Main Results:
- LVEF significantly improved post-PCI (52.9% to 56.1%, p=0.048).
- Greater LVEF improvement was observed in patients with baseline LVEF ≤50% (6.7% increase) compared to those with LVEF >50% (0.7% increase).
- Baseline LVEF ≤50% was the sole independent predictor of LVEF improvement (p<0.001).
Conclusions:
- Successful PCI for unprotected LMCA lesions is associated with significant LVEF improvement.
- Patients with pre-existing depressed LV function (LVEF ≤50%) experience the most substantial LVEF gains.
Background:
Percutaneous coronary intervention (PCI) has been increasingly applied to unprotected left main coronary artery (LMCA) lesions, with varied procedural success and clinical outcomes. However, the effect of PCI on left ventricular performance is still unclear, and there are no clinical studies assessing factors that influence left ventricular ejection fraction (LVEF) in these cases.
Methods:
Between April 1986 and August 2002, de novo PCI was performed for unprotected LMCA stenoses in 199 patients. Close clinical and angiographic follow-up were conducted after the procedure.
Results:
One hundred eighty patients survived over six months and analysis of paired left ventriculography was possible in 175 patients. Improvement in LVEF was observed in the entire population (52.9 +/- 15.7% to 56.1 +/- 14.3%, p = 0.048). The LVEF change was 6.7 +/- 9.5% (p < 0.01) in group with baseline LVEF < or = 50% and 0.7 +/- 6.7 % (p = NS) in group with LVEF > 50%. There was significant intergroup difference (p < 0.001). Patients with baseline diameter stenosis > or = 60% had an improvement of 5.3 +/- 8.3% (p < 0.05) whereas those with stenosis < 60% had no improvement (2.0 +/- 8.4%, p = NS). CK-MB elevation > or = 3 times normal after PCI had a significant inverse association with improvement in LVEF (p < 0.05). Multivariate analysis revealed baseline LVEF < or = 50% was the only independent predictor of improvement in LVEF (standard estimate = 3.509, 95% CI: 2.164-4.854, p < 0.001).
Conclusions:
Successful PCI procedure is associated with significant improvement in LVEF, especially in patients with depressed left ventricular function.
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