Stent implantation in patients with severe left ventricular systolic dysfunction

Carlo Briguori, Tiziana Claudia Aranzulla, Flavio Airoldi, John Cosgrave, Davide Tavano, Iassen Michev, Matteo Montorfano, Mauro Carlino, Alfredo Castelli, Massimo Giuseppe Sangiorgi, Antonio Colombo

Research output: Contribution to journalArticle

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Abstract

Background: Patients with ischemic severe left ventricular (LV) dysfunction are at higher risk for death. We assessed the outcome following percutaneous coronary intervention (PCI) in patients with LV systolic dysfunction. Methods: From April 1993 to March 2004 337 consecutive patients with LV ejection fraction (LVEF) ≤ 35% underwent elective stent implantation at out Institutions. Results: The in-hospital course was uneventful in 322 (95.3%) patients. In-hospital death occurred in 5 patients (1.5%). At 2-year, 83 patients (24.6%) died (Non-surviving group), whereas 254 (75.4%) were alive (Surviving group). Sudden death occurred in 65% of cases. An acute myocardial infarction at follow-up occurred more often in the Non-surviving group (18% versus 5.4%; p = 0.001). An implantable cardioverter-defibrillator (ICD) was implanted in 6.7% of patients in the Non-surviving group versus 20.7% of the Surviving group (p = 0.005). LVEF significantly improved at follow-up only in the Surviving group (29 ± 6 to 35 ± 11; p <0.001), whereas remained unchanged in the Non-surviving group (27 ± 5 to 26 ± 7; p = 0.30).The independent predictors of death at follow-up were: acute myocardial infarction (hazard ratio = 4.94; 95% confidence interval = 2.53-9.64; p <0.001), use of β-blockers (HR = 0.34; 95% CI = 0.18-0.65; p = 0.001), ICD implantation (0.16 [95% CI = 0.05-0.51]; p = 0.002), LVEF <25% (HR = 2.16; 95% confidence interval 1.25-3.76; p = 0.006), and completeness of revascularization (HR = 0.29; 95% CI = 0.10-0.82; p = 0.020). Conclusions: PCI in patients with LVEF ≤ 35% is feasible and safe. Independent predictors of death at 2-year are occurrence of an acute myocardial infarction, treatment by beta blockers, ICD implantation, LVEF <25% and completeness of revascularization.

Original languageEnglish
Pages (from-to)376-384
Number of pages9
JournalInternational Journal of Cardiology
Volume135
Issue number3
DOIs
Publication statusPublished - Jul 10 2009

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Left Ventricular Dysfunction
Stents
Implantable Defibrillators
Myocardial Infarction
Percutaneous Coronary Intervention
Confidence Intervals
Sudden Death
Stroke Volume

Keywords

  • Coronary stent
  • Left ventricular systolic dysfunction
  • Outcome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Stent implantation in patients with severe left ventricular systolic dysfunction. / Briguori, Carlo; Aranzulla, Tiziana Claudia; Airoldi, Flavio; Cosgrave, John; Tavano, Davide; Michev, Iassen; Montorfano, Matteo; Carlino, Mauro; Castelli, Alfredo; Sangiorgi, Massimo Giuseppe; Colombo, Antonio.

In: International Journal of Cardiology, Vol. 135, No. 3, 10.07.2009, p. 376-384.

Research output: Contribution to journalArticle

Briguori, Carlo ; Aranzulla, Tiziana Claudia ; Airoldi, Flavio ; Cosgrave, John ; Tavano, Davide ; Michev, Iassen ; Montorfano, Matteo ; Carlino, Mauro ; Castelli, Alfredo ; Sangiorgi, Massimo Giuseppe ; Colombo, Antonio. / Stent implantation in patients with severe left ventricular systolic dysfunction. In: International Journal of Cardiology. 2009 ; Vol. 135, No. 3. pp. 376-384.
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abstract = "Background: Patients with ischemic severe left ventricular (LV) dysfunction are at higher risk for death. We assessed the outcome following percutaneous coronary intervention (PCI) in patients with LV systolic dysfunction. Methods: From April 1993 to March 2004 337 consecutive patients with LV ejection fraction (LVEF) ≤ 35{\%} underwent elective stent implantation at out Institutions. Results: The in-hospital course was uneventful in 322 (95.3{\%}) patients. In-hospital death occurred in 5 patients (1.5{\%}). At 2-year, 83 patients (24.6{\%}) died (Non-surviving group), whereas 254 (75.4{\%}) were alive (Surviving group). Sudden death occurred in 65{\%} of cases. An acute myocardial infarction at follow-up occurred more often in the Non-surviving group (18{\%} versus 5.4{\%}; p = 0.001). An implantable cardioverter-defibrillator (ICD) was implanted in 6.7{\%} of patients in the Non-surviving group versus 20.7{\%} of the Surviving group (p = 0.005). LVEF significantly improved at follow-up only in the Surviving group (29 ± 6 to 35 ± 11; p <0.001), whereas remained unchanged in the Non-surviving group (27 ± 5 to 26 ± 7; p = 0.30).The independent predictors of death at follow-up were: acute myocardial infarction (hazard ratio = 4.94; 95{\%} confidence interval = 2.53-9.64; p <0.001), use of β-blockers (HR = 0.34; 95{\%} CI = 0.18-0.65; p = 0.001), ICD implantation (0.16 [95{\%} CI = 0.05-0.51]; p = 0.002), LVEF <25{\%} (HR = 2.16; 95{\%} confidence interval 1.25-3.76; p = 0.006), and completeness of revascularization (HR = 0.29; 95{\%} CI = 0.10-0.82; p = 0.020). Conclusions: PCI in patients with LVEF ≤ 35{\%} is feasible and safe. Independent predictors of death at 2-year are occurrence of an acute myocardial infarction, treatment by beta blockers, ICD implantation, LVEF <25{\%} and completeness of revascularization.",
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AU - Briguori, Carlo

AU - Aranzulla, Tiziana Claudia

AU - Airoldi, Flavio

AU - Cosgrave, John

AU - Tavano, Davide

AU - Michev, Iassen

AU - Montorfano, Matteo

AU - Carlino, Mauro

AU - Castelli, Alfredo

AU - Sangiorgi, Massimo Giuseppe

AU - Colombo, Antonio

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N2 - Background: Patients with ischemic severe left ventricular (LV) dysfunction are at higher risk for death. We assessed the outcome following percutaneous coronary intervention (PCI) in patients with LV systolic dysfunction. Methods: From April 1993 to March 2004 337 consecutive patients with LV ejection fraction (LVEF) ≤ 35% underwent elective stent implantation at out Institutions. Results: The in-hospital course was uneventful in 322 (95.3%) patients. In-hospital death occurred in 5 patients (1.5%). At 2-year, 83 patients (24.6%) died (Non-surviving group), whereas 254 (75.4%) were alive (Surviving group). Sudden death occurred in 65% of cases. An acute myocardial infarction at follow-up occurred more often in the Non-surviving group (18% versus 5.4%; p = 0.001). An implantable cardioverter-defibrillator (ICD) was implanted in 6.7% of patients in the Non-surviving group versus 20.7% of the Surviving group (p = 0.005). LVEF significantly improved at follow-up only in the Surviving group (29 ± 6 to 35 ± 11; p <0.001), whereas remained unchanged in the Non-surviving group (27 ± 5 to 26 ± 7; p = 0.30).The independent predictors of death at follow-up were: acute myocardial infarction (hazard ratio = 4.94; 95% confidence interval = 2.53-9.64; p <0.001), use of β-blockers (HR = 0.34; 95% CI = 0.18-0.65; p = 0.001), ICD implantation (0.16 [95% CI = 0.05-0.51]; p = 0.002), LVEF <25% (HR = 2.16; 95% confidence interval 1.25-3.76; p = 0.006), and completeness of revascularization (HR = 0.29; 95% CI = 0.10-0.82; p = 0.020). Conclusions: PCI in patients with LVEF ≤ 35% is feasible and safe. Independent predictors of death at 2-year are occurrence of an acute myocardial infarction, treatment by beta blockers, ICD implantation, LVEF <25% and completeness of revascularization.

AB - Background: Patients with ischemic severe left ventricular (LV) dysfunction are at higher risk for death. We assessed the outcome following percutaneous coronary intervention (PCI) in patients with LV systolic dysfunction. Methods: From April 1993 to March 2004 337 consecutive patients with LV ejection fraction (LVEF) ≤ 35% underwent elective stent implantation at out Institutions. Results: The in-hospital course was uneventful in 322 (95.3%) patients. In-hospital death occurred in 5 patients (1.5%). At 2-year, 83 patients (24.6%) died (Non-surviving group), whereas 254 (75.4%) were alive (Surviving group). Sudden death occurred in 65% of cases. An acute myocardial infarction at follow-up occurred more often in the Non-surviving group (18% versus 5.4%; p = 0.001). An implantable cardioverter-defibrillator (ICD) was implanted in 6.7% of patients in the Non-surviving group versus 20.7% of the Surviving group (p = 0.005). LVEF significantly improved at follow-up only in the Surviving group (29 ± 6 to 35 ± 11; p <0.001), whereas remained unchanged in the Non-surviving group (27 ± 5 to 26 ± 7; p = 0.30).The independent predictors of death at follow-up were: acute myocardial infarction (hazard ratio = 4.94; 95% confidence interval = 2.53-9.64; p <0.001), use of β-blockers (HR = 0.34; 95% CI = 0.18-0.65; p = 0.001), ICD implantation (0.16 [95% CI = 0.05-0.51]; p = 0.002), LVEF <25% (HR = 2.16; 95% confidence interval 1.25-3.76; p = 0.006), and completeness of revascularization (HR = 0.29; 95% CI = 0.10-0.82; p = 0.020). Conclusions: PCI in patients with LVEF ≤ 35% is feasible and safe. Independent predictors of death at 2-year are occurrence of an acute myocardial infarction, treatment by beta blockers, ICD implantation, LVEF <25% and completeness of revascularization.

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