Predicting LVEF After PCI and its Effect on Clinical Outcomes in Patients With Stable Ischemic Cardiomyopathy and
Stephen G Ellis1, Ben Alencherry1, Khaled Ziada1
1Heart, Thoracic and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Abstract:
For most patients with stable ischemic cardiomyopathy (SICM), PCI neither improves LVEF nor heart failure outcomes. We sought to ascertain if specific subgroups of SICM patients might have a LVEF and clinical benefit from PCI. From a cohort of 1702 consecutive SICM patients with LVEF ≤50% treated between 2009 and 2023, patients were randomly selected for screening to meet final inclusion criteria including target vessel subtending ≥20% of the LV, hibernation+ischemia>scar, timely pre- and post PCI echos and no intercurrent treatment that might influence change in LVEF, until a cohort of 200 patients was available. Parsimoniously selected variables were then assessed for correlation with change in LVEF, with 1000-fold bootstrapping to minimize overfitting. Correlation of change in LVEF with freedom from cardiac death or heart failure admission was assessed with Cox multivariable analysis. Mean age was 69 ± 10 yrs, 76% were male, 52% had diabetes and baseline LVEF obtained a median 9 days before PCI was 35% ± 11%. Post-PCI LVEF obtained at a median 132 days was 39% ± 11%. Median follow-up was 35 months. After consideration of medication usage, the presence of an ICD, baseline LVEF >35%, prior CABG and scar all were independently and negatively correlated with improvement in LVEF (p ≤0.035). Patients with none of these factors had an improvement in LVEF of 5.5% ± 7.4%. Post-PCI LVEF and change in LVEF were independently correlated with reduced risk of clinical events (p = 0.003 and p = 0.032, respectively). If validated, these data will change the paradigm that no patients with SICM have a heart failure or mortality benefit from PCI.
