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

Kalpa De Silva1, Ian Webb, Pierre Sicard

  • 1Cardiovascular Division, Rayne Institute, St Thomas' Hospital Campus, King's College London, London, UK.

Coronary Artery Disease
|March 8, 2012
PubMed

Insights

Left ventricular dysfunction significantly increases mortality risk after percutaneous coronary intervention (PCI). Assessing left ventricular ejection fraction (LVEF) before PCI is crucial for patient risk stratification and improved outcomes.

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.
Abstract

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