Short- and long-term outcomes of percutaneous coronary intervention in patients with low, intermediate and high ejection fraction

Summary

Background:

Reduced ejection fraction (EF) has previously been shown to be a risk factor for adverse outcomes in patients undergoing percutaneous coronary intervention (PCI). However, with the advent of stents, procedural complications and restenosis rates have reduced dramatically. The aim of this study was to assess the association between left ventricular (LV ) ejection fraction and in-hospital and longterm outcomes using a prospective registry.

Methods

After exclusion of patients with acute myocardial infarction (MI) and those with missing data on left ventricular ejection fraction, 2 030 patients undergoing PCI between March 2002 and 2004 remained in our prospective registry. Patients were divided into three categories: group 1: EF ≤ 40% ( n = 293), group 2: EF = 41−49% ( n = 268) and group 3: EF ≥ 50% ( n = 1 469). The frequency of in-hospital and follow-up outcomes between groups was compared using appropriate statistical methods.

Results

Stents were used for over 85% of the patients in each group. The mean EF ± SD in the lowest to highest EF groups was 35.8 ± 5.4%, 45.5 ± 1.6% and 57 ± 5.7%, respectively. The angiographic and procedural success rates were 91.8, 92.1 and 94.1%, ( p = 0.16); and 91.1, 90.3 and 92.9%, ( p = 0.09), respectively. The respective cumulative major adverse cardiac events (MACE) and cardiac death rates at follow-up were 5.8, 2.2 and 3.3% ( p = 0.04) and 2, 0.4 and 0.3% ( p = 0.02), respectively. The hazards ratio (95% CI) for MACE and cardiac death in the lowest versus highest EF groups were 2.07 (1.03−4.16) and 5.49 (1.29−23.3).

Conclusions

Patients with significant left ventricular dysfunction had higher long-term major adverse cardiac events and cardiac death rates. Even the use of newer techniques such as stenting did not compensate for this.