Does left ventricular function continue to influence mortality following contemporary percutaneous coronary...

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Historically, left ventricular (LV) dysfunction predicted poor outcomes post-percutaneous coronary intervention (PCI).
• Technological advancements in PCI have improved safety, but the role of pre-PCI LV function remains unclear.
• Current risk models often omit pre-procedural LV ejection fraction (LVEF) assessment.

Purpose of the Study:

• To evaluate the impact of pre-procedural left ventricular ejection fraction (LVEF) on mortality after PCI.
• To determine if LVEF remains an independent predictor of outcomes in the current era of PCI.
• To assess the utility of LVEF in risk stratification for patients undergoing PCI.

Main Methods:

• Analysis of 2328 consecutive patients undergoing PCI between April 2005 and July 2009.
• Patients categorized by pre-PCI LVEF: good (≥50%), moderate (30-49%), and poor (<30%).
• Mortality data tracked via the UK Office of National Statistics; logistic regression used for risk prediction.

Main Results:

• Overall 30-day mortality was 1.0% and long-term mortality was 5%.
• Kaplan-Meier analysis showed significantly divergent survival curves based on LVEF categories (P<0.0001).
• Impaired LVEF (≤50%) independently predicted higher 30-day (HR 4.20) and long-term (HR 1.67) all-cause mortality.

Conclusions:

• Left ventricular impairment is a significant independent predictor of both early and late mortality following PCI.
• Pre-procedural LV function assessment, specifically LVEF, is vital for accurate risk stratification.
• Routine LVEF assessment before PCI is recommended for patient optimization and improved clinical outcomes.