title: Stent implantation in patients with severe left ventricular systolic dysfunction.
abstract: BACKGROUND
  Patients with ischemic severe left ventricular (LV) dysfunction are at higher risk for death. We assessed the outcome following percutaneous coronary intervention (PCI) in patients with LV systolic dysfunction.
  
  
  METHODS
  From April 1993 to March 2004 337 consecutive patients with LV ejection fraction (LVEF)<or=35% underwent elective stent implantation at out Institutions.
  
  
  RESULTS
  The in-hospital course was uneventful in 322 (95.3%) patients. In-hospital death occurred in 5 patients (1.5%). At 2-year, 83 patients (24.6%) died (Non-surviving group), whereas 254 (75.4%) were alive (Surviving group). Sudden death occurred in 65% of cases. An acute myocardial infarction at follow-up occurred more often in the Non-surviving group (18% versus 5.4%; p=0.001). An implantable cardioverter-defibrillator (ICD) was implanted in 6.7% of patients in the Non-surviving group versus 20.7% of the Surviving group (p=0.005). LVEF significantly improved at follow-up only in the Surviving group (29+/-6 to 35+/-11; p<0.001), whereas remained unchanged in the Non-surviving group (27+/-5 to 26+/-7; p=0.30).The independent predictors of death at follow-up were: acute myocardial infarction (hazard ratio=4.94; 95% confidence interval=2.53-9.64; p<0.001), use of beta-blockers (HR=0.34; 95% CI=0.18-0.65; p=0.001), ICD implantation (0.16 [95% CI=0.05-0.51]; p=0.002), LVEF<25% (HR=2.16; 95% confidence interval 1.25-3.76; p=0.006), and completeness of revascularization (HR=0.29; 95% CI=0.10-0.82; p=0.020).
  
  
  CONCLUSIONS
  PCI in patients with LVEF<or=35% is feasible and safe. Independent predictors of death at 2-year are occurrence of an acute myocardial infarction, treatment by beta blockers, ICD implantation, LVEF<25% and completeness of revascularization.
authors.affiliation: Department of Cardiology, Clinica Mediterranea, Naples, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Briguori
authors.forename: Tiziana Claudia
authors.initials: TC
authors.lastname: Aranzulla
authors.forename: Flavio
authors.initials: F
authors.lastname: Airoldi
authors.forename: John
authors.initials: J
authors.lastname: Cosgrave
authors.forename: Davide
authors.initials: D
authors.lastname: Tavano
authors.forename: Iassen
authors.initials: I
authors.lastname: Michev
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.forename: Mauro
authors.initials: M
authors.lastname: Carlino
authors.forename: Alfredo
authors.initials: A
authors.lastname: Castelli
authors.forename: Massimo Giuseppe
authors.initials: MG
authors.lastname: Sangiorgi
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000628:therapy*