title: Safety of drug-eluting stents in patients with left ventricular dysfunction undergoing percutaneous coronary intervention.
abstract: Recent studies have reported a higher incidence of late stent thrombosis in patients undergoing drug-eluting stent (DES). Reduced left ventricular (LV) ejection fraction (EF) is considered a risk factor for this complication after both bare-metal stent (BMS) and DES implantation. Therefore, the aim of this study was to evaluate the safety of DES on long-term follow-up in patients with LV dysfunction undergoing percutaneous coronary intervention. We retrospectively selected all patients with an EF <45% undergoing percutaneous coronary intervention with implantation of > or =1 sirolimus- or paclitaxel-eluting stent at our institution. The primary endpoint of the study was all-cause mortality, retrieved using both Social Security Database and hospital records. We also compared the results of this group with a historical cohort of patients with LV dysfunction undergoing BMS implantation; 121 patients who received > or =1 DES were enrolled. The mean LVEF was 36 +/- 8%, with 20 patients (16%) with a LVEF < or =25%; 36 patients (30%) had diabetes mellitus, and DES implantation was considered off-label in 100 patients (83%). Survival at 1-, 2-, and 3-year follow-up was 94% (95% confidence interval [CI] 88 to 100), 90% (95% CI 82 to 98) and 88% (95% CI 80 to 96), respectively. In conclusion, the favorable results of this study demonstrate the safety of DES in patients with LV dysfunction.
authors.affiliation: VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA. aabbate@mcvh-vcu.edu
authors.forename: Annunziata
authors.initials: A
authors.lastname: Nusca
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lipinski
authors.forename: Amit
authors.initials: A
authors.lastname: Varma
authors.forename: Darryn L
authors.initials: DL
authors.lastname: Appleton
authors.forename: Evelyne
authors.initials: E
authors.lastname: Goudreau
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Cowley
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Wittkamp
authors.forename: Germano
authors.initials: G
authors.lastname: Di Sciascio
authors.forename: George W
authors.initials: GW
authors.lastname: Vetrovec
authors.forename: Antonio
authors.initials: A
authors.lastname: Abbate
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D015906:Angioplasty, Balloon, Coronary; D003920:Diabetes Mellitus / Q000453:epidemiology; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage; D013318:Stroke Volume; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000401:mortality* / Q000601:surgery*
chemical_list: D000319:Adrenergic beta-Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D017239:Paclitaxel; D020123:Sirolimus