Short and Long-Term Outcomes of Percutaneous Coronary Intervention in Patients with Low; Intermediate and High Ejection Fraction : Cardiovascular Topics

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 85of the patients in each group. The mean EF + SD in the lowest to highest EF groups was 35.8 + 5.4; 45.5 + 1.6and 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 (95CI) 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). Conclusion : 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

In-Hospital and Mid-Term Adverse Clinical Outcomes of a Direct Stenting Strategy Versus Stenting after Predilatation for the Treatment of Coronary Artery Lesions : Cardiovascular Topic

Background : Direct stenting without balloon dilatation may reduce procedural costs and duration; and hypothetically; the restenosis rate. This study was designed to compare the in-hospital and long-term outcomes of direct stenting (DS) versus stenting after pre-dilatation (PS) in our routine clinical practice. Methods : The 1 603 patients treated with stenting for single coronary lesions were enrolled into a prospective registry. Patients with acute myocardial infarction (MI) within the preceding 48 hours; and those with highly calcified lesions; total occlusions; or a lesion in a saphenous graft were excluded. The baseline; angiographic and procedural data; in-hospital outcomes and follow-up data were recorded in our database and analysed with appropriate statistical methods. Results : Eight hundred and fifty-seven patients (53.5) were treated with DS and 746 (46.5) underwent PS. In the DS group; lesions were shorter in length; larger in diameter and had lower pre-procedural diameter stenosis. Type C and diffuse lesions and drug-eluting stents were found less often (p 0.001). With univariate analysis; dissection and non-Q-wave MI occurred less frequently in this group (0.2 and 0.6vs 3.9 and 2.1; p 0.001 and p ; p = 0.79). With multivariate analysis; direct stenting reduced the risk of dissection (OR = 0.07; 95CI: 0.01-0.33; but neither the cumulative endpoint of MACE (OR = 1.1; 95CI = 0.58-2.11; p = 0.7) nor its constructing components were different between the groups. Conclusions : Direct stenting in the real world has at least similar long-term outcomes in patients treated with stenting after pre-dilatation; and is associated with lower dissection rates