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Risk Stratification by Coronary Perfusion Pressure in Left Ventricular Systolic Dysfunction Patients Undergoing
Ming-Jer Hsieh1,2, Chun-Chi Chen1,2, Dong-Yi Chen1,2
1Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Insights
Coronary perfusion pressure (CPP) influences survival outcomes in patients with left ventricular systolic dysfunction (LVSD) undergoing revascularization. Lower CPP (≤42 mmHg) indicates higher mortality risk with incomplete revascularization compared to complete revascularization.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Myocardial perfusion is influenced by coronary perfusion pressure (CPP) and coronary artery stenosis.
- The impact of CPP on survival outcomes following revascularization remains unclear.
Purpose of the Study:
- To investigate the prognostic role of CPP in patients with left ventricular systolic dysfunction (LVSD).
- To evaluate the association between CPP and survival after percutaneous coronary intervention (PCI) with complete revascularization (CR) or reasonable incomplete revascularization (RIR).
Main Methods:
- Retrospective analysis of 6,076 patients from a registry.
- Definition of CR (rSS = 0) and RIR (0
- Propensity score matching used to compare RIR and CR groups, with all-cause mortality as the primary endpoint.
Main Results:
- 816 LVSD patients undergoing CR or RIR were analyzed; 134 deaths occurred over a 4.6-year follow-up.
- CPP and RIR were independent predictors of mortality.
- In patients with CPP > 42 mmHg, RIR survival was similar to CR (HR 1.20; p=0.513).
- In patients with CPP ≤ 42 mmHg, RIR was associated with significantly higher mortality than CR (HR 2.39; p=0.007).
Conclusions:
- CPP plays a crucial role in risk stratification for revascularization strategies in LVSD patients.
- For LVSD patients with CPP > 42 mmHg, RIR offers survival outcomes comparable to CR.
- For LVSD patients with CPP ≤ 42 mmHg, CR is associated with significantly better survival than RIR.
Background:
Coronary perfusion pressure (CPP) and coronary artery stenosis are responsible for myocardial perfusion. However, how CPP-related survival outcome affects revascularization is unclear.
Objective:
The aim of this study is to investigate the prognostic role of CPP in patients with left ventricular systolic dysfunction (LVSD) undergoing percutaneous coronary intervention (PCI) with complete revascularization (CR) or reasonable incomplete revascularization (RIR).
Methods:
We retrospectively screened 6,076 consecutive patients in a registry. The residual synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) score (rSS) was used to define CR (rSS = 0) and RIR (0
Results:
In total, 816 patients with LVSD who underwent CR or RIR were enrolled. After a mean follow-up of 4.6 years, 134 patients died. Both CPP and RIR independently predicted mortality in the total population. After 1:1 matching, 175 pairs of RIR and CR were found in patients with CPP > 42 mmHg. Moreover, 101 pairs of RIR and CR were present in patients with CPP ≤ 42 mmHg. In patients with CPP > 42 mmHg, RIR was not significantly different from CR in long-term mortality [hazard ratio (HR) 1.20; 95% confidence interval (CI):0.70-2.07; p = 0.513]; However, in patients with CPP≤42 mmHg, RIR had a significantly higher mortality risk than CR (HR 2.39; 95% CI: 1.27-4.50; p = 0.007).
Conclusions:
The CPP had a risk stratification role in selecting different revascularization strategies in patients with LVSD. When patients with LVSD had CPP > 42 mmHg, RIR was equivalent to CR in survival. However, when patients with LVSD had CPP ≤ 42 mmHg, RIR had a significantly higher mortality risk than CR.
