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Percutaneous coronary intervention among patients with left ventricular systolic dysfunction: a review and
Vijayalakshmi Kunadian1, Andrew Pugh, Azfar G Zaman
1Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK. vijay.kunadian@newcastle.ac.uk
Insights
Percutaneous coronary intervention (PCI) for left ventricular systolic dysfunction shows acceptable in-hospital and long-term mortality, similar to coronary artery bypass surgery (CABG). However, neither revascularization method may improve outcomes over pharmacological therapy alone.
Area of Science:
- Cardiology
- Interventional Cardiology
- Heart Failure Management
Background:
- Coronary artery disease (CAD) is a primary cause of left ventricular dysfunction.
- Coronary artery bypass surgery (CABG) has not demonstrated mortality benefits for patients with CAD and left ventricular systolic dysfunction on guideline-directed medical therapy.
- The efficacy of percutaneous coronary intervention (PCI) in this patient group remains unclear.
Purpose of the Study:
- To conduct a meta-analysis evaluating in-hospital and long-term mortality rates.
- To assess the outcomes of PCI in patients with left ventricular systolic dysfunction (ejection fraction ≤ 40%).
Main Methods:
- A systematic literature search was performed using keywords related to poor left ventricle function, PCI, revascularization, LV dysfunction, and heart failure.
- Included studies focused on patients undergoing PCI for CAD with concurrent left ventricular systolic dysfunction.
- Studies lacking long-term mortality data or originating from the same center were excluded.
Main Results:
- The meta-analysis included 19 studies with 4766 patients (mean age 65 years, 80% male, mean ejection fraction 30%).
- Pooled in-hospital mortality was 1.8% (95% CI 1.0-2.9%) and pooled long-term mortality (24 months) was 15.6% (95% CI 11.0-20.7%).
- Comparison of PCI versus CABG in five studies showed similar long-term mortality (relative risk 0.98, P=0.83).
Conclusions:
- PCI is a feasible revascularization strategy for patients with left ventricular systolic dysfunction, exhibiting acceptable in-hospital and long-term mortality.
- PCI outcomes appear comparable to those of CABG in this patient population.
- Neither PCI nor CABG may offer a survival advantage over optimal pharmacological therapy alone.
Background:
Coronary artery disease (CAD) is the most common cause for left ventricular dysfunction. Coronary artery bypass surgery (CABG) has not reduced mortality among patients with CAD and left ventricular systolic dysfunction receiving guideline-indicated pharmacological therapy. However, the benefit of percutaneous coronary intervention (PCI) among patients with left ventricular systolic dysfunction is not clear.
Objectives:
A meta-analysis of studies utilizing PCI among patients with left ventricular systolic dysfunction (ejection fraction ≤ 40%) was performed to determine in-hospital and long-term (≥ 1 year) mortality.
Methods:
A systematic computerized literature search was performed using the search terms 'poor left ventricle', 'percutaneous coronary intervention', 'revascularization', 'LV dysfunction' and 'heart failure'. Studies of patients undergoing PCI for CAD in the presence of left ventricular systolic dysfunction were included. Studies that did not report long-term mortality data and same-centre studies were excluded.
Results:
In total, 4766 patients from 19 studies were included in this meta-analysis. The mean (pooled estimate) age was 65 years [95% confidence interval (CI) 62-68] with 80% (95% CI 75-84%) males. The mean (pooled estimate) ejection fraction was 30% (95% CI 27-33%). The in-hospital mortality using random-effects model (13 studies, total PCI n=2202) was 1.8%, n=39 (95% CI 1.0-2.9%). The long-term mortality (mean pooled estimate 24 months) using the random-effects model (19 studies, total follow-up n=2937) was 15.6%, n=401 (95% CI 11.0-20.7%). Five studies compared PCI versus CABG (n=455 vs. n=502) and provide long-term mortality data (deaths-PCI: n=102 vs. CABG: n=115). The relative risk using the random-effects model (PCI vs. CABG) was 0.98 (95% CI 0.8-1.2, P=0.83).
Conclusion:
The present meta-analysis demonstrates that on the basis of available clinical studies, PCI among patients with left ventricular systolic dysfunction is feasible with acceptable in-hospital and long-term mortality and yields similar outcomes to CABG. However, neither intervention may improve outcome compared with pharmacological therapy alone.
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