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Published on: June 28, 2019
[Remote results of myocardial endovascular revascularization in patients with low ejection fraction]
V V Bazylev1, M G Shmatkov1, A I P'ianzin1
1Federal Centre of Cardiovascular Surgery under the RF Ministry of Public Health, Penza, Russia.
Insights
Complete or incomplete endovascular revascularization effectively treats patients with low left ventricular ejection fraction (LLVEF). Both approaches showed similar outcomes in echocardiographic parameters, repeat revascularization rates, and survival.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Low left ventricular ejection fraction (LLVEF) independently predicts complications and mortality in open cardiac surgery.
- Myocardial endovascular revascularization offers lower intraoperative and early postoperative complication rates.
- Percutaneous coronary intervention (PCI) may not achieve anatomically complete myocardial revascularization.
Purpose of the Study:
- To compare the remote results of complete versus incomplete endovascular myocardial revascularization in patients with LLVEF.
- To evaluate echocardiographic parameters, need for repeat revascularization, and survival rates.
- To address the scarcity of data on revascularization completeness in patients with severely reduced ejection fraction.
Main Methods:
- Prospective, single-centre study of 151 patients with ischemic heart disease and LLVEF (<35%).
- Patients underwent myocardial endovascular revascularization and were divided into complete (n=87) and incomplete (n=64) revascularization groups.
- Comparison of echocardiographic alterations, repeat revascularization incidence, and remote survival rates.
Main Results:
- Both complete and incomplete endovascular revascularization were effective in patients with LLVEF.
- No statistically significant differences were found between the groups regarding echocardiographic parameters.
- Similar rates of repeat myocardial revascularization and survival were observed in both complete and incomplete revascularization groups.
Conclusions:
- Endovascular revascularization, whether complete or incomplete, demonstrates efficacy in patients with LLVEF.
- The completeness of revascularization did not significantly impact long-term echocardiographic outcomes, clinical relapse, or survival in this cohort.
- These findings support the consideration of endovascular revascularization even when complete anatomical revascularization is not achieved in high-risk patients.
Abstract:
Despite the present-day level of the development of cardiac surgery, a low left ventricular ejection fraction (LLVEF) is an important independent predictor of high complication rates and increased in-hospital mortality related to open surgical interventions. The method of myocardial endovascular revascularization is associated with the lowest rates of both intraoperative and early postoperative complications. However, percutaneous coronary intervention (PCI) does not always make it possible to perform anatomically complete myocardial revascularization. Comparisons of the remote results of anatomically complete and incomplete revascularization of the myocardium in the world literature seem to be extremely scarce and ambiguous, with a low ejection fraction in the majority of cases being an exclusion criterion. In order to elucidate these problems we carried out a prospective, single-centre study, including a total of 151 patients suffering from ischaemic heart disease with a left ventricular ejection fraction of less than 35%, who were subjected to myocardial endovascular revascularization. The patients were divided into 2 groups: those with complete (n=87) and incomplete (n=64) revascularization, followed by comparing the alterations in the echocardiographic parameters, assessing the incidence of repeat myocardial revascularization due to a relapse of the clinical course of angina pectoris, and the survival rate in the remote period. The obtained findings were suggestive of efficacy of both complete and incomplete endovascular revascularization of the myocardium in patients with a low left ventricular ejection fraction (LLVEF), with no statistically significant differences between the patients of both groups in the examined parameters revealed.
