[Outcome of patients with coronary artery disease and left ventricular ejection fraction less than 50% undergoing
1Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Insights
Patients with reduced left ventricular ejection fraction (LVEF) <50% undergoing percutaneous coronary intervention (PCI) face higher risks of death and in-stent thrombosis. This study highlights LVEF <50% as an independent risk factor for adverse outcomes post-PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Heart Failure
Background:
- Reduced left ventricular ejection fraction (LVEF) is a significant predictor of cardiovascular events.
- Percutaneous coronary intervention (PCI) is a common revascularization strategy for coronary artery disease.
- The outcomes of PCI in patients with impaired LVEF require further investigation.
Purpose of the Study:
- To evaluate the in-hospital and long-term clinical outcomes of patients with LVEF <50% undergoing PCI.
- To identify LVEF <50% as an independent risk factor for adverse events after PCI.
Main Methods:
- A prospective study included 10,445 patients undergoing PCI, divided into LVEF ≥50% (n=9,896) and LVEF <50% (n=549) groups.
- In-hospital and 2-year clinical outcomes were compared between groups.
- Multivariable Cox regression and propensity score matching were used to assess the association between LVEF <50% and outcomes.
Main Results:
- Patients with LVEF <50% had significantly higher rates of in-hospital and 2-year all-cause death, cardiac death, in-stent thrombosis, myocardial infarction, and MACCE compared to those with LVEF ≥50%.
- LVEF <50% was identified as an independent risk factor for 2-year all-cause death, cardiac death, and in-stent thrombosis.
- After propensity score matching, LVEF <50% remained an independent risk factor for 2-year all-cause death, cardiac death, and in-stent thrombosis.
Conclusions:
- Reduced LVEF (<50%) is an independent risk factor for adverse outcomes, including death and in-stent thrombosis, following PCI.
- PCI in patients with LVEF <50% is associated with increased risks of mortality and thrombotic events.
- The study did not find increased risks of target-vessel revascularization, bleeding, or stroke in patients with LVEF <50%.
Abstract:
Objective: To investigate the in-hospital and long-term outcomes of patients with left ventricular ejection fraction (LVEF) <50% undergoing percutaneous coronary intervention (PCI) . Methods: From January to December 2013, 10 445 consecutive patients who underwent PCI in Fuwai Hospital and the LVEF value was available were prospectively included. The patients were divided into LVEF≥50% group (9 896 cases) and LVEF<50% group (549 cases) . The in-hospital and 2-year clinical outcomes were compared between the 2 groups. The association between LVEF<50% and clinical outcomes was assessed using multivariable Cox regression analysis. Results: (1) Compared with LVEF ≥50% group, LVEF< 50% group had higher rates of in-hospital all-cause death (1.1% (6/549) vs. 0.2% (17/9 896) , P<0.01) , cardiac death (1.1% (6/549) vs. 0.1% (12/9 896) , P<0.01) , in-stent thrombosis (0.7% (4/549) vs. 0.2% (18/9 896) , P<0.01) , myocardial infarction (2.4% (13/549) vs. 1.2% (121/9 896) , P<0.05) ,and major adverse cardiovascular and cerebrovascular events (MACCE) which including death, myocardial infarction, revascularization, in-stent thrombosis, and stroke (3.6% (20/549) vs. 1.4% (137/9 896) , P<0.01) . (2) A total of 10 388 (99.5%) patients completed 2-year follow-up. Compared with LVEF ≥50% group, LVEF<50% group had higher rates of 2-year all-cause death (4.7% (26/549) vs. 1.0% (101/9 896) , P<0.01) , cardiac death (4.0% (22/549) vs. 0.5% (50/9 896) , P<0.01) , in-stent thrombosis (3.1% (17/549) vs. 0.7% (71/9 896) , P<0.001) , myocardial infarction (4.2% (23/549) vs. 1.9% (186/9 896) , P<0.01) ,and MACCE (17.9% (98/549) vs. 11.8% (1 172/9 896) , P<0.01) . There were no significant differences on the rates of 2-year target-vessel revascularization, bleeding and stroke between the two groups. (3) The multivariable Cox regression analysis demonstrated that LVEF< 50% was the independent risk factor of 2-year all-cause death (HR=2.47, 95%CI 1.49-4.08, P<0.01) , cardiac death (HR=3.25, 95%CI 1.79-5.90, P<0.01) , in-stent thrombosis (HR=4.19, 95%CI 2.39-7.34, P<0.01) , myocardial infarction (HR=2.00, 95%CI 1.26-3.16, P<0.01) , and MACCE (HR=1.40, 95%CI 1.13-1.74, P<0.01) . (4) After propensity score matching, all in-hospital outcomes were similar between the two groups, including all-cause death, cardiac death, in-stent thrombosis, myocardial infarction, revascularization, bleeding, stroke, and MACCE (all P>0.05) . After propensity score matching,the multivariable Cox regression analysis demonstrated that LVEF<50% was still an independent risk factor of 2-year all-cause death (HR=3.08, 95%CI 1.37-6.89, P<0.01) , cardiac death (HR= 4.12, 95%CI 1.53-11.07, P<0.01) ,and in-stent thrombosis (HR=3.82, 95%CI 1.27-11.5, P<0.05) . Conclusion: LVEF< 50% is an independent risk factor of 2-year all-cause death, cardiac death, and in-stent thrombosis in patients undergoing PCI, but it does not increase the risk of target-vessel revascularization, bleeding or stroke.
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