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Impact of left ventricular ejection fraction on outcomes after left main revascularization: g-LM Registry
Amin Daoulah1, Maryam Jameel Naser2, Ahmad S Hersi3
1Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia.
Insights
Left ventricular dysfunction impacts outcomes in unprotected left main coronary artery disease revascularization. Percutaneous coronary intervention may offer advantages over coronary artery bypass graft in specific patient groups.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Left ventricular dysfunction is a significant factor in cardiovascular disease.
- The impact of left ventricular ejection fraction on outcomes after unprotected left main coronary artery disease revascularization is not fully understood.
- Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) are primary revascularization strategies.
Purpose of the Study:
- To evaluate the impact of left ventricular ejection fraction (LVEF) on clinical outcomes.
- To compare PCI versus CABG in patients with unprotected left main coronary artery disease (ULMCA) stratified by LVEF.
Main Methods:
- Retrospective observational study (Gulf Left Main Registry, Jan 2015-Dec 2019).
- 2137 ULMCA patients undergoing PCI (n=1221) or CABG (n=916).
- Patients stratified into low (l-LVEF <40%), mid-range (m-LVEF 40-49%), and preserved (p-LVEF ≥50%) LVEF subgroups. Primary outcomes: in-hospital and follow-up major adverse cardiovascular and cerebrovascular events (MACCE) and mortality.
Main Results:
- Higher in-hospital MACCE observed in l-LVEF and m-LVEF groups.
- Higher total mortality in m-LVEF and p-LVEF groups undergoing CABG.
- No significant difference in mortality between PCI and CABG in the l-LVEF group during hospitalization.
- At 15-month follow-up, no difference in MACCE or mortality between PCI and CABG for p-LVEF and m-LVEF groups.
Conclusions:
- CABG was associated with higher in-hospital adverse events.
- Hospital mortality was comparable between CABG and PCI for patients with low LVEF.
- PCI may offer an advantage in reducing MACCE at 15-month follow-up for patients with low LVEF.
Aims:
The impact of left ventricular dysfunction on clinical outcomes following revascularization is not well established in patients with unprotected left main coronary artery disease (ULMCA). In this study, we evaluated the impact of left ventricular ejection fraction (LVEF) on clinical outcomes of patients with ULMCA requiring revascularization with percutaneous coronary intervention (PCI) compared with coronary artery bypass graft (CABG).
Methods:
The details of the design, methods, end points, and relevant definitions are outlined in the Gulf Left Main Registry: a retrospective, observational study conducted between January 2015 and December 2019 across 14 centres in 3 Gulf countries. In this study, the data on patients with ULMCA who underwent revascularization through PCI or CABG were stratified by LVEF into three main subgroups; low (l-LVEF <40%), mid-range (m-LVEF 40-49%), and preserved (p-LVEF ≥50%). Primary outcomes were hospital major adverse cardiovascular and cerebrovascular events (MACCE) and mortality and follow-up MACCE and mortality.
Results:
A total of 2137 patients were included; 1221 underwent PCI and 916 had CABG. During hospitalization, MACCE was significantly higher in patients with l-LVEF [(10.10%), P = 0.005] and m-LVEF [(10.80%), P = 0.009], whereas total mortality was higher in patients with m-LVEF [(7.40%), P = 0.009] and p-LVEF [(7.10%), P = 0.045] who underwent CABG. There was no mortality difference between groups in patients with l-LVEF. At a median follow-up of 15 months, there was no difference in MACCE and total mortality between patients who underwent CABG or PCI with p-LVEF and m-LVEF.
Conclusion:
CABG was associated with higher in-hospital events. Hospital mortality in patients with l-LVEF was comparable between CABG and PCI. At 15 months' follow-up, PCI could have an advantage in decreasing MACCE in patients with l-LVEF.
