ABSTRACT
BACKGROUND: Despite the well-known prognostic impact of systolic dysfunction in unselected patients undergoing percutaneous coronary intervention (PCI), limited data are available on its current predictive role after PCI for unprotected left main disease (ULM). We thus appraised the prognostic role of left ventricular ejection fraction (LVEF) in patients undergoing PCI for ULM with drug-eluting stents (DES). METHODS: Consecutive eligible subjects were retrospectively enrolled in a national registry. Patients were divided into three groups: LVEF < 30%, LVEF 30-45%, and LVEF > 45%. Relevant baseline and outcome data were compared with bivariate and multivariable tests. RESULTS: A total of 975 subjects was included (LVEF < 30%: 46, LVEF 30-45%: 208, LVEF > 45%: 721). Patients with LVEF < 30% had several other unfavorable clinical features, including older age and higher EuroSCORE. Adverse event rates were different already at 7 days (p = 0.012 for all-cause death and p = 0.015 for major adverse cardiac events [MACE]), with even more significant trends up to 30 days and at long-term (p < 0.001 for death, and p < 0.001 for MACE). After a median of 18 months, risk of death totaled 39 versus 13 versus 8% (p < 0.001) and risk of MACE 44 versus 24 versus 22% (p = 0.003). Multivariable analyses showed however that reduced LVEF was not an independent predictor of adverse events at any time-point. CONCLUSIONS: Whereas reduced LVEF is apparently a significant predictor of adverse events after PCI with DES for ULM, its prognostic impact is mostly due to clustering with other adverse features.
Subject(s)
Angioplasty, Balloon, Coronary/instrumentation , Coronary Artery Disease/therapy , Drug-Eluting Stents , Stroke Volume , Ventricular Dysfunction, Left/complications , Ventricular Function, Left , Aged , Aged, 80 and over , Angioplasty, Balloon, Coronary/adverse effects , Angioplasty, Balloon, Coronary/mortality , Cause of Death , Chi-Square Distribution , Coronary Artery Disease/complications , Coronary Artery Disease/mortality , Coronary Artery Disease/physiopathology , Female , Humans , Italy , Logistic Models , Male , Middle Aged , Myocardial Infarction/etiology , Myocardial Infarction/mortality , Odds Ratio , Patient Selection , Prosthesis Design , Registries , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , Ventricular Dysfunction, Left/mortality , Ventricular Dysfunction, Left/physiopathologyABSTRACT
Aim of this paper was to evaluate the effects of changes in obesity status on lung function decline over an 8-year follow-up. Adults over 24 years (n=1212) from the general population, who participated in both Po River Delta first (PD1, 1980-1982) and second (PD2, 1988-1991) epidemiological surveys, were stratified as "never obese" (BMI < 30 Kg/m(2) at both PD1 and PD2), "becoming obese" (BMI < 30 Kg/m(2) at PD1 and > or = 30 Kg/m(2) at PD2), "always obese" (BMI > or = 30 Kg/m(2) at both PD1 and PD2), and "becoming non-obese" (BMI > or = 30 Kg/m(2) at PD1 and < 30Kg/m(2) at PD2). Linear regression models for changes in FEV(1), FVC, and VC (computed as absolute differences between the values at PD2 and those at PD1) with longitudinal categories of obesity, gender, age, and baseline smoking habits as covariates were applied. The "becoming obese" and "always obese" categories had a significantly greater decline of lung function than "never obese" group; in the "always obese" group, this was true for vital capacities but not FEV(1). Conversely, in the "becoming non-obese" group lung function was at PD2 improved with respect to PD1. Compared with "Never obese" the mean increase in lung function was of 93, 180, and 48 mL for FEV(1), FVC, and VC, respectively. In this general population sample, remaining or becoming obese increases the decline in lung function over 8 years, while becoming non-obese decreases it.
