Determinants of outcome in patients with chronic ischemic left ventricular dysfunction undergone percutaneous coronary interventions

Enrico Ammirati, Valentina Guida, Azeem Latib, Francesco Moroni, Francesco Arioli, Isabella Scotti, Ornella E. Rimoldi, Antonio Colombo, Paolo G. Camici

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Percutaneous coronary interventions (PCI) in patients with ischemic systolic left ventricular dysfunction (SLVD) are routinely performed although their impact on prognosis remains unclear. Methods: We retrospectively evaluated 385 consecutive patients (76% male, 66 ± 9years) with SLVD (left ventricular ejection fraction [LVEF] ≤40%) due to chronic coronary artery disease, who underwent PCI between 1999 and 2009, and explored clinical factors associated with higher risk of death or of a composite of death and hospitalization for acute decompensated heart failure (ADHF). Results: The median follow-up was 28months (inter-quartile range 14-46 months). Death and the composite outcome of death and hospitalization for ADHF occurred in 80 (21%) and 109 (28%) patients respectively (8.4 and 11.5 per 100 patient-years of follow-up). Insulin-dependent diabetes mellitus (IDDM), multivessel disease, LVEF <35%, symptoms of heart failure (HF) emerged both as independent predictors of death (adjusted hazard ratios [HR] 2.64; 1.92, 1.88 and 1.67 respectively) and composite outcome of death and hospitalization for ADHF (adjusted HR 2.22, 1.92, 1.79 and 1.94 respectively). Furthermore advanced age (HR = 1.03) emerged as independent predictors of death and having performed a stress test before PCI correlated with reduced number of deaths and ADHF hospitalizations (HR = 0.60). Of note, PCI significantly reduced the symptom of angina from 63.2% at baseline to 16.3% at the last follow up (p <0.0001). Conclusions: IDDM, symptoms of HF, multivessel disease and LVEF <35% appear to be associated with worse outcome patients with ischemic SLVD undergoing PCI, and may be taken into account for optimal risk stratification. On the other hand, performing a stress testing before PCI seems to be associated with a more favorable outcome.

Original languageEnglish
Article number137
JournalBMC Cardiovascular Disorders
Volume15
Issue number1
DOIs
Publication statusPublished - Oct 26 2015

Keywords

  • Coronary artery disease
  • Coronary revascularization
  • Heart failure
  • Ischemic systolic left ventricular dysfunction
  • Percutaneous coronary intervention; stress testing

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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