Appraising the impact of left ventricular ejection fraction on outcomes of percutaneous drug-eluting stenting for unprotected left main disease: Insights from a multicenter registry of 975 patients

Giuseppe Biondi-Zoccai, Imad Sheiban, Claudio Moretti, Tullio Palmerini, Antonio Marzocchi, Davide Capodanno, Corrado Tamburino, Massimo Margheri, Giuseppe Vecchi, Giuseppe Sangiorgi, Andrea Santarelli, Antonio L. Bartorelli, Carlo Briguori, Luigi Vignali, Francesco Di Pede, Angelo Ramondo, Massimo Medda, Marco De Carlo, Giovanni Falsini, Alberto BenassiCataldo Palmieri, Vincenzo Filippone, Diego Sangiorgi, Fabio Barlocco, Stefano De Servi

Research output: Contribution to journalArticle

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Abstract

Background: Despite the well-known prognostic impact of systolic dysfunction in unselected patients undergoing percutaneous coronary intervention (PCI), limited data are available on its current predictive role after PCI for unprotected left main disease (ULM). We thus appraised the prognostic role of left ventricular ejection fraction (LVEF) in patients undergoing PCI for ULM with drug-eluting stents (DES). Methods: Consecutive eligible subjects were retrospectively enrolled in a national registry. Patients were divided into three groups: LVEF <30%, LVEF 30-45%, and LVEF > 45%. Relevant baseline and outcome data were compared with bivariate and multivariable tests. Results: A total of 975 subjects was included (LVEF <30%: 46, LVEF 30-45%: 208, LVEF > 45%: 721). Patients with LVEF <30% had several other unfavorable clinical features, including older age and higher EuroSCORE. Adverse event rates were different already at 7 days (p = 0.012 for all-cause death and p = 0.015 for major adverse cardiac events [MACE]), with even more significant trends up to 30 days and at long-term (p <0.001 for death, and p <0.001 for MACE). After a median of 18 months, risk of death totaled 39 versus 13 versus 8% (p <0.001) and risk of MACE 44 versus 24 versus 22% (p = 0.003). Multivariable analyses showed however that reduced LVEF was not an independent predictor of adverse events at any time-point. Conclusions: Whereas reduced LVEF is apparently a significant predictor of adverse events after PCI with DES for ULM, its prognostic impact is mostly due to clustering with other adverse features.

Original languageEnglish
Pages (from-to)403-411
Number of pages9
JournalClinical Research in Cardiology
Volume100
Issue number5
DOIs
Publication statusPublished - May 2011

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Stroke Volume
Registries
Percutaneous Coronary Intervention
Pharmaceutical Preparations
Drug-Eluting Stents
Cluster Analysis
Cause of Death

Keywords

  • Coronary artery disease
  • Heart failure
  • Left ventricular dysfunction
  • Percutaneous transluminal coronary angioplasty
  • Stent

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Appraising the impact of left ventricular ejection fraction on outcomes of percutaneous drug-eluting stenting for unprotected left main disease : Insights from a multicenter registry of 975 patients. / Biondi-Zoccai, Giuseppe; Sheiban, Imad; Moretti, Claudio; Palmerini, Tullio; Marzocchi, Antonio; Capodanno, Davide; Tamburino, Corrado; Margheri, Massimo; Vecchi, Giuseppe; Sangiorgi, Giuseppe; Santarelli, Andrea; Bartorelli, Antonio L.; Briguori, Carlo; Vignali, Luigi; Pede, Francesco Di; Ramondo, Angelo; Medda, Massimo; De Carlo, Marco; Falsini, Giovanni; Benassi, Alberto; Palmieri, Cataldo; Filippone, Vincenzo; Sangiorgi, Diego; Barlocco, Fabio; De Servi, Stefano.

In: Clinical Research in Cardiology, Vol. 100, No. 5, 05.2011, p. 403-411.

Research output: Contribution to journalArticle

Biondi-Zoccai, G, Sheiban, I, Moretti, C, Palmerini, T, Marzocchi, A, Capodanno, D, Tamburino, C, Margheri, M, Vecchi, G, Sangiorgi, G, Santarelli, A, Bartorelli, AL, Briguori, C, Vignali, L, Pede, FD, Ramondo, A, Medda, M, De Carlo, M, Falsini, G, Benassi, A, Palmieri, C, Filippone, V, Sangiorgi, D, Barlocco, F & De Servi, S 2011, 'Appraising the impact of left ventricular ejection fraction on outcomes of percutaneous drug-eluting stenting for unprotected left main disease: Insights from a multicenter registry of 975 patients', Clinical Research in Cardiology, vol. 100, no. 5, pp. 403-411. https://doi.org/10.1007/s00392-010-0258-z
Biondi-Zoccai, Giuseppe ; Sheiban, Imad ; Moretti, Claudio ; Palmerini, Tullio ; Marzocchi, Antonio ; Capodanno, Davide ; Tamburino, Corrado ; Margheri, Massimo ; Vecchi, Giuseppe ; Sangiorgi, Giuseppe ; Santarelli, Andrea ; Bartorelli, Antonio L. ; Briguori, Carlo ; Vignali, Luigi ; Pede, Francesco Di ; Ramondo, Angelo ; Medda, Massimo ; De Carlo, Marco ; Falsini, Giovanni ; Benassi, Alberto ; Palmieri, Cataldo ; Filippone, Vincenzo ; Sangiorgi, Diego ; Barlocco, Fabio ; De Servi, Stefano. / Appraising the impact of left ventricular ejection fraction on outcomes of percutaneous drug-eluting stenting for unprotected left main disease : Insights from a multicenter registry of 975 patients. In: Clinical Research in Cardiology. 2011 ; Vol. 100, No. 5. pp. 403-411.
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abstract = "Background: Despite the well-known prognostic impact of systolic dysfunction in unselected patients undergoing percutaneous coronary intervention (PCI), limited data are available on its current predictive role after PCI for unprotected left main disease (ULM). We thus appraised the prognostic role of left ventricular ejection fraction (LVEF) in patients undergoing PCI for ULM with drug-eluting stents (DES). Methods: Consecutive eligible subjects were retrospectively enrolled in a national registry. Patients were divided into three groups: LVEF <30{\%}, LVEF 30-45{\%}, and LVEF > 45{\%}. Relevant baseline and outcome data were compared with bivariate and multivariable tests. Results: A total of 975 subjects was included (LVEF <30{\%}: 46, LVEF 30-45{\%}: 208, LVEF > 45{\%}: 721). Patients with LVEF <30{\%} had several other unfavorable clinical features, including older age and higher EuroSCORE. Adverse event rates were different already at 7 days (p = 0.012 for all-cause death and p = 0.015 for major adverse cardiac events [MACE]), with even more significant trends up to 30 days and at long-term (p <0.001 for death, and p <0.001 for MACE). After a median of 18 months, risk of death totaled 39 versus 13 versus 8{\%} (p <0.001) and risk of MACE 44 versus 24 versus 22{\%} (p = 0.003). Multivariable analyses showed however that reduced LVEF was not an independent predictor of adverse events at any time-point. Conclusions: Whereas reduced LVEF is apparently a significant predictor of adverse events after PCI with DES for ULM, its prognostic impact is mostly due to clustering with other adverse features.",
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T1 - Appraising the impact of left ventricular ejection fraction on outcomes of percutaneous drug-eluting stenting for unprotected left main disease

T2 - Insights from a multicenter registry of 975 patients

AU - Biondi-Zoccai, Giuseppe

AU - Sheiban, Imad

AU - Moretti, Claudio

AU - Palmerini, Tullio

AU - Marzocchi, Antonio

AU - Capodanno, Davide

AU - Tamburino, Corrado

AU - Margheri, Massimo

AU - Vecchi, Giuseppe

AU - Sangiorgi, Giuseppe

AU - Santarelli, Andrea

AU - Bartorelli, Antonio L.

AU - Briguori, Carlo

AU - Vignali, Luigi

AU - Pede, Francesco Di

AU - Ramondo, Angelo

AU - Medda, Massimo

AU - De Carlo, Marco

AU - Falsini, Giovanni

AU - Benassi, Alberto

AU - Palmieri, Cataldo

AU - Filippone, Vincenzo

AU - Sangiorgi, Diego

AU - Barlocco, Fabio

AU - De Servi, Stefano

PY - 2011/5

Y1 - 2011/5

N2 - Background: Despite the well-known prognostic impact of systolic dysfunction in unselected patients undergoing percutaneous coronary intervention (PCI), limited data are available on its current predictive role after PCI for unprotected left main disease (ULM). We thus appraised the prognostic role of left ventricular ejection fraction (LVEF) in patients undergoing PCI for ULM with drug-eluting stents (DES). Methods: Consecutive eligible subjects were retrospectively enrolled in a national registry. Patients were divided into three groups: LVEF <30%, LVEF 30-45%, and LVEF > 45%. Relevant baseline and outcome data were compared with bivariate and multivariable tests. Results: A total of 975 subjects was included (LVEF <30%: 46, LVEF 30-45%: 208, LVEF > 45%: 721). Patients with LVEF <30% had several other unfavorable clinical features, including older age and higher EuroSCORE. Adverse event rates were different already at 7 days (p = 0.012 for all-cause death and p = 0.015 for major adverse cardiac events [MACE]), with even more significant trends up to 30 days and at long-term (p <0.001 for death, and p <0.001 for MACE). After a median of 18 months, risk of death totaled 39 versus 13 versus 8% (p <0.001) and risk of MACE 44 versus 24 versus 22% (p = 0.003). Multivariable analyses showed however that reduced LVEF was not an independent predictor of adverse events at any time-point. Conclusions: Whereas reduced LVEF is apparently a significant predictor of adverse events after PCI with DES for ULM, its prognostic impact is mostly due to clustering with other adverse features.

AB - Background: Despite the well-known prognostic impact of systolic dysfunction in unselected patients undergoing percutaneous coronary intervention (PCI), limited data are available on its current predictive role after PCI for unprotected left main disease (ULM). We thus appraised the prognostic role of left ventricular ejection fraction (LVEF) in patients undergoing PCI for ULM with drug-eluting stents (DES). Methods: Consecutive eligible subjects were retrospectively enrolled in a national registry. Patients were divided into three groups: LVEF <30%, LVEF 30-45%, and LVEF > 45%. Relevant baseline and outcome data were compared with bivariate and multivariable tests. Results: A total of 975 subjects was included (LVEF <30%: 46, LVEF 30-45%: 208, LVEF > 45%: 721). Patients with LVEF <30% had several other unfavorable clinical features, including older age and higher EuroSCORE. Adverse event rates were different already at 7 days (p = 0.012 for all-cause death and p = 0.015 for major adverse cardiac events [MACE]), with even more significant trends up to 30 days and at long-term (p <0.001 for death, and p <0.001 for MACE). After a median of 18 months, risk of death totaled 39 versus 13 versus 8% (p <0.001) and risk of MACE 44 versus 24 versus 22% (p = 0.003). Multivariable analyses showed however that reduced LVEF was not an independent predictor of adverse events at any time-point. Conclusions: Whereas reduced LVEF is apparently a significant predictor of adverse events after PCI with DES for ULM, its prognostic impact is mostly due to clustering with other adverse features.

KW - Coronary artery disease

KW - Heart failure

KW - Left ventricular dysfunction

KW - Percutaneous transluminal coronary angioplasty

KW - Stent

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