title: The impact of ejection fraction on outcomes after percutaneous coronary intervention in patients with congestive heart failure: an analysis of the National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry and Dynamic Registry.
abstract: BACKGROUND
  Patients with congestive heart failure (CHF) have higher rates of adverse outcomes after percutaneous coronary intervention (PCI). A comprehensive analysis of outcomes in patients with CHF in the current era has not been done. We studied the outcomes of patients with CHF who underwent PCI in the National Heart, Lung, and Blood Institute-sponsored Percutaneous Transluminal Coronary Angioplasty (PTCA) and Dynamic registries.
  
  
  METHODS
  We evaluated demographic and angiographic characteristics and the clinical outcomes of patients with CHF in the Dynamic Registry and the PTCA Registry, excluding patients with acute myocardial infarction. In the Dynamic Registry, patients with CHF (n = 503) were compared with patients without CHF (n = 4194), and patients with CHF with a preserved ejection fraction (EF) (n = 134) were compared with patients with CHF who have a reduced EF (n = 199). The patients with CHF in the 1997 through 2001 Dynamic Registry (n = 236) were then similarly compared with patients with CHF in the earlier PTCA Registry (n = 117).
  
  
  RESULTS
  In the Dynamic Registry, compared with patients without CHF, patients with CHF had a higher-risk clinical and angiographic profile, and a higher mortality rate both inhospital (2.6% vs 0.4%, P < or = .001) and at 1 year (13.1% vs 3.0%, P < .001). Patients with reduced EF had higher inhospital mortality rates and a trend toward higher mortality at 1 year. The patients with CHF in the Dynamic Registry compared with those in the PTCA Registry had a higher risk profile yet had significantly higher procedural success rates and improved clinical outcomes.
  
  
  CONCLUSIONS
  Although CHF remains a strong predictor of adverse outcomes after PCI, significant improvement seen in the past decade is likely related to improved procedural techniques and improved medical therapy.
authors.affiliation: University of Chicago, Chicago, IL 60637, USA. eholper@medicine.bsd.uchicago.edu
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Holper
authors.forename: John
authors.initials: J
authors.lastname: Blair
authors.forename: Faith
authors.initials: F
authors.lastname: Selzer
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Detre
authors.forename: Alice K
authors.initials: AK
authors.lastname: Jacobs
authors.forename: David O
authors.initials: DO
authors.lastname: Williams
authors.forename: Helen
authors.initials: H
authors.lastname: Vlachos
authors.forename: Robert L
authors.initials: RL
authors.lastname: Wilensky
authors.forename: Paul
authors.initials: P
authors.lastname: Coady
authors.forename: David P
authors.initials: DP
authors.lastname: Faxon
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D006333:Heart Failure / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome