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Left Ventricular Ejection Fraction Change Following Percutaneous Coronary Intervention: Correlates and Association
Gjin Ndrepepa1, Salvatore Cassese1, Robert A Byrne2,3
1Department of Cardiology, Deutsches Herzzentrum München Technische Universität München Munich Germany.
Insights
Percutaneous coronary intervention (PCI) can improve left ventricular ejection fraction (LVEF), significantly reducing long-term mortality in patients with coronary artery disease and reduced LVEF. Improvement in LVEF post-PCI is linked to better survival rates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Outcomes Research
Background:
- The impact of changes in left ventricular ejection fraction (LVEF) after percutaneous coronary intervention (PCI) on long-term mortality in coronary artery disease (CAD) patients requires further investigation.
- Understanding the relationship between LVEF improvement and survival post-PCI is crucial for optimizing patient management.
Purpose of the Study:
- To evaluate the effect of PCI on LVEF in patients with CAD.
- To determine the association between LVEF change (ΔLVEF) after PCI and 5-year mortality rates.
Main Methods:
- Observational study of 8181 patients with CAD undergoing PCI.
- Paired LVEF measurements at baseline and 6-8 months post-PCI.
- Analysis of 5-year mortality rates based on ΔLVEF categories (reduced, mildly improved, largely improved) and baseline LVEF.
Main Results:
- PCI led to significant LVEF improvements, particularly in patients with lower baseline LVEF.
- A larger improvement in ΔLVEF was associated with a significantly reduced 5-year mortality rate for both all-cause and cardiac death.
- The mortality benefit of LVEF improvement was most pronounced in patients with baseline LVEF <40%.
Conclusions:
- Improvement in LVEF following PCI is associated with reduced long-term mortality in patients with coronary artery disease.
- This survival benefit is particularly evident in patients who had reduced LVEF before the intervention.
Background:
The association between left ventricular ejection fraction (LVEF) change (ΔLVEF) following percutaneous coronary intervention (PCI) and the long-term mortality rate in patients with coronary artery disease is incompletely investigated. We aimed to assess the impact of PCI on LVEF and the association of ΔLVEF after PCI with the long-term mortality rate.
Methods And Results:
This observational study included 8181 patients with paired angiographic LVEF measurements performed at baseline and 6 to 8 months following the index PCI. ΔLVEF was defined as LVEF measured on the 6- to 8-month angiography minus LVEF measured on the baseline angiography. LVEF change was classified according to the following categories: reduced (ΔLVEF <0), mildly improved (ΔLVEF >0% to <10%) and largely improved (ΔLVEF ≥10%). The primary outcome was the 5-year mortality rate. In patients with baseline LVEF <40%, 40% to <50% and ≥50%, ΔLVEF (median [25th-75th percentiles]) was 6.0% [0.0% to 14.0%], 4.0% [-1.0% to 11.0%] and 0.0% [-4.0% to 3.0%], respectively (P<0.001). In patients with reduced, mildly improved, and largely improved ΔLVEF, the 5-year mortality rate (n=712) was 29.1%, 23.1%, and 16.5%, respectively, in patients with baseline LVEF <40%; 17.0%, 12.2% and 9.8%, respectively, in patients with baseline LVEF 40% to <50%; and 7.8%, 7.1%, and 5.6%, respectively, in patients with baseline LVEF ≥50% (adjusted hazard ratio [HR], 0.91 [95% CI, 0.86-0.96]; P<0.001) for all-cause death and adjusted (HR, 0.86 [95% CI, 0.81-0.92]; P<0.001) for cardiac death, calculated for 5% higher ΔLVEF.
Conclusions:
In patients with coronary artery disease undergoing PCI, improvement of LVEF following PCI was associated with a reduced long-term mortality rate in patients with reduced LVEF but not in patients with preserved LVEF before intervention.
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