Determinants of outcome in patients with chronic ischemic left ventricular dysfunction undergone percutaneous
Enrico Ammirati1,2,3, Valentina Guida4, Azeem Latib4
1IRCCS Ospedale San Raffaele and Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy. ammirati.enrico@hsr.it.
Insights
Percutaneous coronary interventions (PCI) for systolic left ventricular dysfunction (SLVD) show unclear prognostic impact. Key risk factors for adverse outcomes include diabetes, heart failure symptoms, and reduced ejection fraction, while stress testing may improve prognosis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Heart Failure Research
Background:
- Percutaneous coronary interventions (PCI) are common for ischemic systolic left ventricular dysfunction (SLVD).
- The prognostic impact of PCI in SLVD patients remains incompletely understood.
- SLVD is defined by a left ventricular ejection fraction (LVEF) ≤40%.
Purpose of the Study:
- To evaluate clinical factors associated with adverse outcomes in SLVD patients undergoing PCI.
- To identify predictors of death and a composite of death/acute decompensated heart failure (ADHF) hospitalization.
- To assess the impact of pre-PCI stress testing on patient prognosis.
Main Methods:
- Retrospective analysis of 385 consecutive SLVD patients (LVEF ≤40%) who underwent PCI (1999-2009).
- Evaluation of clinical factors, including insulin-dependent diabetes mellitus (IDDM), multivessel disease, LVEF, heart failure symptoms, and age.
- Assessment of outcomes including all-cause mortality and hospitalization for ADHF.
Main Results:
- Median follow-up was 28 months; 21% experienced death and 28% experienced the composite outcome.
- Independent predictors of worse outcomes included IDDM, multivessel disease, LVEF <35%, and HF symptoms.
- Pre-PCI stress testing was associated with reduced mortality and ADHF hospitalizations (HR=0.60).
- PCI significantly reduced angina symptoms from 63.2% to 16.3% (p<0.0001).
Conclusions:
- IDDM, HF symptoms, multivessel disease, and LVEF <35% are associated with worse prognosis in SLVD patients undergoing PCI.
- These factors should inform risk stratification for optimal patient management.
- Pre-PCI stress testing may be linked to a more favorable patient outcome.
Background:
Percutaneous coronary interventions (PCI) in patients with ischemic systolic left ventricular dysfunction (SLVD) are routinely performed although their impact on prognosis remains unclear.
Methods:
We retrospectively evaluated 385 consecutive patients (76 % male, 66 ± 9 years) with SLVD (left ventricular ejection fraction [LVEF] ≤40 %) due to chronic coronary artery disease, who underwent PCI between 1999 and 2009, and explored clinical factors associated with higher risk of death or of a composite of death and hospitalization for acute decompensated heart failure (ADHF).
Results:
The median follow-up was 28 months (inter-quartile range 14-46 months). Death and the composite outcome of death and hospitalization for ADHF occurred in 80 (21 %) and 109 (28 %) patients respectively (8.4 and 11.5 per 100 patient-years of follow-up). Insulin-dependent diabetes mellitus (IDDM), multivessel disease, LVEF < 35 %, symptoms of heart failure (HF) emerged both as independent predictors of death (adjusted hazard ratios [HR] 2.64; 1.92, 1.88 and 1.67 respectively) and composite outcome of death and hospitalization for ADHF (adjusted HR 2.22, 1.92, 1.79 and 1.94 respectively). Furthermore advanced age (HR = 1.03) emerged as independent predictors of death and having performed a stress test before PCI correlated with reduced number of deaths and ADHF hospitalizations (HR = 0.60). Of note, PCI significantly reduced the symptom of angina from 63.2 % at baseline to 16.3 % at the last follow up (p < 0.0001).
Conclusions:
IDDM, symptoms of HF, multivessel disease and LVEF < 35 % appear to be associated with worse outcome patients with ischemic SLVD undergoing PCI, and may be taken into account for optimal risk stratification. On the other hand, performing a stress testing before PCI seems to be associated with a more favorable outcome.
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