Determinants of outcome in patients with chronic ischemic left ventricular dysfunction undergone percutaneous coronary interventions.
BACKGROUND
Percutaneous coronary interventions (PCI) in patients with ischemic systolic left ventricular dysfunction (SLVD) are routinely performed although their impact on prognosis remains unclear.


METHODS
We retrospectively evaluated 385 consecutive patients (76 % male, 66 ± 9 years) with SLVD (left ventricular ejection fraction [LVEF] ≤40 %) due to chronic coronary artery disease, who underwent PCI between 1999 and 2009, and explored clinical factors associated with higher risk of death or of a composite of death and hospitalization for acute decompensated heart failure (ADHF).


RESULTS
The median follow-up was 28 months (inter-quartile range 14-46 months). Death and the composite outcome of death and hospitalization for ADHF occurred in 80 (21 %) and 109 (28 %) patients respectively (8.4 and 11.5 per 100 patient-years of follow-up). Insulin-dependent diabetes mellitus (IDDM), multivessel disease, LVEF < 35 %, symptoms of heart failure (HF) emerged both as independent predictors of death (adjusted hazard ratios [HR] 2.64; 1.92, 1.88 and 1.67 respectively) and composite outcome of death and hospitalization for ADHF (adjusted HR 2.22, 1.92, 1.79 and 1.94 respectively). Furthermore advanced age (HR = 1.03) emerged as independent predictors of death and having performed a stress test before PCI correlated with reduced number of deaths and ADHF hospitalizations (HR = 0.60). Of note, PCI significantly reduced the symptom of angina from 63.2 % at baseline to 16.3 % at the last follow up (p < 0.0001).


CONCLUSIONS
IDDM, symptoms of HF, multivessel disease and LVEF < 35 % appear to be associated with worse outcome patients with ischemic SLVD undergoing PCI, and may be taken into account for optimal risk stratification. On the other hand, performing a stress testing before PCI seems to be associated with a more favorable outcome.
IRCCS Ospedale San Raffaele and Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy. ammirati.enrico@hsr.it.|Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy. ammirati.enrico@hsr.it.|Cardiothoracic Department, San Raffaele Scientific Institute and University, Via Olgettina 60, 20132, Milan,, Italy. ammirati.enrico@hsr.it.
Enrico
E
Ammirati
IRCCS Ospedale San Raffaele and Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
Valentina
V
Guida
IRCCS Ospedale San Raffaele and Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
Azeem
A
Latib
IRCCS Ospedale San Raffaele and Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
Francesco
F
Moroni
A.O. Ospedale di Circolo di Busto Arsizio, Busto Arsizio, VA, Italy.
Francesco
F
Arioli
Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy.
Isabella
I
Scotti
CNR Institute of Clinical Physiology, Milan, Italy.
Ornella E
OE
Rimoldi
IRCCS Ospedale San Raffaele and Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy.|EMO-GVM Centro Cuore Columbus, Milan, Italy.
Antonio
A
Colombo
IRCCS Ospedale San Raffaele and Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy. camici.paolo@hsr.it.
Paolo G
PG
Camici
D000368:Aged; D003327:Coronary Disease / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003925:Diabetic Angiopathies / Q000150:complications; D005260:Female; D006333:Heart Failure / Q000150:complications; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications*; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications*