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Impact of depressed left ventricular function on outcomes in patients with three-vessel coronary disease undergoing
Zhan Gao1, Bo Xu, Ajay J Kirtane
1Cardiovascular Institute & Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China.
Insights
Patients with multivessel coronary artery disease and low left ventricular ejection fraction (LVEF) undergoing percutaneous coronary intervention face higher risks of major adverse cardiac events and cardiac death. Left ventricular dysfunction is a significant predictor of poor outcomes in this high-risk group.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Multivessel coronary artery disease (CAD) with reduced left ventricular ejection fraction (LVEF) identifies a high-risk patient cohort for coronary revascularization.
- Limited data exist regarding the efficacy and safety of percutaneous coronary intervention (PCI) in this specific population.
Purpose of the Study:
- To evaluate the in-hospital and long-term outcomes of patients with multivessel CAD and low LVEF undergoing PCI.
- To identify the impact of reduced LVEF on adverse cardiac events following PCI for multivessel disease.
Main Methods:
- A cohort of 4335 patients with three-vessel disease undergoing PCI was analyzed.
- Patients were stratified into two groups: low ejection fraction (EF) (LVEF < 40%, n=191) and preserved EF (LVEF ≥ 40%, n=4144).
- In-hospital and long-term outcomes, including major adverse cardiac events (MACE), cardiac death, myocardial infarction (MI), and target vessel revascularization (TVR), were compared between groups.
Main Results:
- The low EF group exhibited significantly higher two-year rates of MACE (19.64% vs. 8.73%), cardiac death (10.30% vs. 1.33%), and MI (10.32% vs. 2.28%) compared to the preserved EF group (P < 0.01 for all).
- No significant difference was observed in TVR rates between the low EF and preserved EF groups (6.18% vs. 6.11%, P = 0.96).
- Cox proportional hazard models identified LVEF < 40% as a significant risk factor for cardiac death (OR: 4.779), MI (OR: 2.673), and MACE (OR: 1.827), but not for TVR (OR: 1.094).
Conclusions:
- Left ventricular dysfunction in patients undergoing PCI for multivessel CAD is associated with increased risks of cardiac death, both in-hospital and during long-term follow-up.
- PCI may be considered for multivessel CAD patients with low LVEF, but careful risk stratification and management are crucial due to elevated risks of adverse cardiac events.
Background:
Patients with multivessel coronary artery disease and depressed left ventricular ejection fraction (LVEF) represent a high risk group of patients for coronary revascularization. There are limited data on percutaneous coronary intervention treatment in this population.
Methods:
Among a cohort of 4335 patients with three-vessel disease with or without left main disease undergoing percutaneous coronary intervention, 191 patients had LVEF < 40% (low ejection fraction (EF)) and 4144 patients had LVEF ≥ 40%. In-hospital and long-term outcomes were examined according to LVEF.
Results:
The estimated two-year rates of major adverse cardiac events, cardiac death, and myocardial infarction were significantly higher in the low EF group (19.64% vs. 8.73%, Log-rank test: P < 0.01; 10.30% vs. 1.33%, Log-rank test: P < 0.01, and 10.32% vs. 2.28%, Log-rank test: P < 0.01 respectively), but there was no difference in the rates of target vessel revascularization (6.18% vs. 6.11%, Log-rank test: P = 0.96). Using the Cox proportional hazard models, LVEF < 40% was a significant risk factor for cardiac death, myocardial infarction, and major adverse cardiac events (OR (95%CI): 4.779 (2.369 - 9.637), 2.673 (1.353 - 5.282), and 1.827 (1.187 - 2.813) respectively), but was not a statistically significant risk factor for target vessel revascularization (OR (95%CI): 1.094 (0.558 - 2.147)).
Conclusion:
Among patients undergoing percutaneous coronary intervention for multivessel coronary artery disease, left ventricular dysfunction remains associated with further risk of cardiac death in-hospital and during long-term follow-up.
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