Appraising the impact of left ventricular ejection fraction on outcomes of percutaneous drug-eluting stenting for unprotected left main disease: insights from a multicenter registry of 975 patients.
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.
Divisione di Cardiologia, Universita` di Torino, San Giovanni Battista Molinette Hospital, Corso Bramante 88-90, 10126, Turin, Italy. gbiondizoccai@gmail.com
Giuseppe
G
Biondi-Zoccai
Imad
I
Sheiban
Claudio
C
Moretti
Tullio
T
Palmerini
Antonio
A
Marzocchi
Davide
D
Capodanno
Corrado
C
Tamburino
Massimo
M
Margheri
Giuseppe
G
Vecchi
Giuseppe
G
Sangiorgi
Andrea
A
Santarelli
Antonio L
AL
Bartorelli
Carlo
C
Briguori
Luigi
L
Vignali
Francesco di
Fd
Pede
Angelo
A
Ramondo
Massimo
M
Medda
Marco
M
de Carlo
Giovanni
G
Falsini
Alberto
A
Benassi
Cataldo
C
Palmieri
Vincenzo
V
Filippone
Diego
D
Sangiorgi
Fabio
F
Barlocco
Stefano
S
de Servi
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002423:Cause of Death; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D016017:Odds Ratio; D018579:Patient Selection; D011474:Prosthesis Design; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D016277:Ventricular Function, Left