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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
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Percutaneous coronary intervention outcomes in patients with stable coronary disease and left ventricular systolic

Adam D DeVore1,2, Eric Yow2, Mitchell W Krucoff1,2

  • 1Department of Medicine, Duke University School of Medicine, Durham, NC, USA.

ESC Heart Failure
|September 28, 2019
PubMed

Insights

Percutaneous coronary intervention (PCI) did not improve mortality or hospitalizations in stable coronary artery disease (CAD) patients with reduced ejection fraction. Further research is needed for other outcomes in this high-risk group.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Heart Failure

Background:

  • Stable coronary artery disease (CAD) with moderate to severe left ventricular systolic dysfunction is a high-risk condition.
  • The role of percutaneous coronary intervention (PCI) in improving outcomes for these patients remains unclear.
  • Left ventricular ejection fraction (LVEF) ≤35% indicates significant impairment in heart pumping function.

Purpose of the Study:

  • To evaluate the effectiveness of PCI in addition to medical therapy for patients with stable CAD and reduced LVEF.
  • To assess the impact of PCI on long-term mortality and cardiovascular hospitalizations.
  • To investigate outcomes in a propensity-matched cohort to minimize confounding factors.

Main Methods:

  • Analysis of patients with stable CAD and LVEF ≤35% from the Duke Databank for Cardiovascular Disease (1995-2012).
  • Exclusion of patients with acute coronary syndrome or severe angina.
  • Propensity-matched Cox proportional hazards analysis comparing PCI versus medical therapy alone.

Main Results:

  • A cohort of 444 patients (222 pairs) was matched based on 24 variables.
  • Over a median of 7 years, no significant difference in all-cause mortality was observed between PCI and medical therapy groups (HR 0.87; 95% CI 0.68-1.10).
  • The composite endpoint of all-cause mortality or cardiovascular hospitalization also showed no significant difference (HR 1.18; 95% CI 0.96-1.44).

Conclusions:

  • In patients with stable CAD amenable to PCI and moderate/severe left ventricular systolic dysfunction, PCI addition to medical therapy did not improve long-term mortality.
  • PCI did not significantly reduce the composite of mortality or cardiovascular hospitalization in this high-risk population.
  • The impact of PCI on other clinical outcomes in these patients warrants further investigation.
Abstract

Keywords:
Coronary artery diseaseHeart failureLeft ventricular dysfunctionOutcomes

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