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

ABSTRACT

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