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Published on: May 28, 2019
Short- and long-term outcomes of percutaneous coronary intervention in patients with low, intermediate and high
M Alidoosti1, M Salarifar, A M Zeinali
1Tehran Heart Centre, Medical Sciences, University of Tehran, Tehran, Iran. alidostm@sina.tums.ac.ir
Insights
Patients with reduced left ventricular ejection fraction (EF) undergoing percutaneous coronary intervention (PCI) face higher risks of adverse cardiac events and death. Advanced techniques like stenting do not fully mitigate these long-term risks.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Reduced left ventricular ejection fraction (EF) is a known risk factor for adverse outcomes in patients undergoing percutaneous coronary intervention (PCI).
- The widespread adoption of coronary stents has significantly reduced procedural complications and restenosis rates.
Purpose of the Study:
- To evaluate the association between left ventricular ejection fraction (EF) and both in-hospital and long-term outcomes in patients undergoing PCI.
- To assess if modern interventional techniques can overcome the risks associated with impaired EF.
Main Methods:
- A prospective registry of 2,030 patients undergoing PCI (excluding acute myocardial infarction) was analyzed.
- Patients were stratified into three groups based on EF:
- In-hospital and follow-up outcomes were compared across the EF groups using statistical analysis.
Main Results:
- Stent use exceeded 85% across all EF groups.
- No significant differences in angiographic or procedural success rates were observed between groups (p > 0.09).
- Patients with lower EF (
Conclusions:
- Significant left ventricular dysfunction is associated with increased long-term risks of major adverse cardiac events and cardiac death following PCI.
- Current interventional strategies, including stenting, do not fully compensate for the adverse prognostic impact of reduced ejection fraction.
Background:
Reduced ejection fraction (EF) has previously been shown to be a risk factor for adverse outcomes in patients undergoing percutaneous coronary intervention (PCI). However, with the advent of stents, procedural complications and restenosis rates have reduced dramatically. The aim of this study was to assess the association between left ventricular (LV ) ejection fraction and in-hospital and longterm outcomes using a prospective registry.
Methods:
After exclusion of patients with acute myocardial infarction (MI) and those with missing data on left ventricular ejection fraction, 2 030 patients undergoing PCI between March 2002 and 2004 remained in our prospective registry. Patients were divided into three categories: group 1: EF
Results:
Stents were used for over 85% of the patients in each group. The mean EF +/- SD in the lowest to highest EF groups was 35.8 +/- 5.4%, 45.5 +/- 1.6% and 57 +/- 5.7%, respectively. The angiographic and procedural success rates were 91.8, 92.1 and 94.1%, (p = 0.16); and 91.1, 90.3 and 92.9%, (p = 0.09), respectively. The respective cumulative major adverse cardiac events (MACE) and cardiac death rates at follow-up were 5.8, 2.2 and 3.3% (p = 0.04) and 2, 0.4 and 0.3% (p = 0.02), respectively. The hazards ratio (95% CI) for MACE and cardiac death in the lowest versus highest EF groups were 2.07 (1.03-4.16) and 5.49 (1.29-23.3).
Conclusions:
Patients with significant left ventricular dysfunction had higher long-term major adverse cardiac events and cardiac death rates. Even the use of newer techniques such as stenting did not compensate for this.
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