title: Effect of left ventricular systolic dysfunction on secondary medical prevention and clinical outcome in stable coronary artery disease patients.
abstract: BACKGROUND
  Limited recent data are available in the literature on whether the presence of left ventricular systolic dysfunction (LVSD) affects the therapeutic management of patients with stable coronary artery disease (CAD).
  
  
  OBJECTIVE
  The objectives of this study were to analyse prevalence, effect on therapeutics and prognosis of LVSD in stable CAD.
  
  
  METHODS
  We prospectively included 4184 CAD outpatients free from any myocardial infarction or coronary revascularization for>1year. Left ventricular ejection fraction (EF) was available for 4124 (98.6%) patients. Follow-up was performed at 2years. All events were adjudicated blindly.
  
  
  RESULTS
  The mean EF was 57.5±10.8%, and 201 (4.9%) patients had an EF≤35%. The prescription of renin-angiotensin system inhibitors and beta-blockers was inversely related to EF, and reached>90% in patients with EF≤35%. Seventy-five (37.3%) of the patients with EF≤35% received a mineralocorticoid receptor antagonist. Eighty-five (42.3%) of the patients with EF≤35% had an implantable cardioverter defibrillator. Clinical follow-up data were obtained for 4090 patients (99.2%). Event rates were higher in patients with low EF (adjusted hazard ratio [95% confidence interval] for EF≤35%, with EF≥60% as reference: 3.93 [2.60-5.93] and 7.12 [3.85-13.18], for all-cause death and cardiovascular death, respectively).
  
  
  CONCLUSIONS
  In patients with stable CAD, LVSD is well taken into account by cardiologists, with extensive use of evidence-based medications and interventions. Despite this, LVSD remains a major prognostic indicator in this population.
authors: CHRU de Lille, 59037 Lille, France; Inserm U1167, Institut Pasteur de Lille, université Lille Nord de France, 59000 Lille, France; Faculté de médecine de Lille, 59045 Lille, France.
authors: Nicolas
authors: N
authors: Lamblin
authors: Polyclinique du Bois, 59003 Lille, France.
authors: Thibaud
authors: T
authors: Meurice
authors: Centre hospitalier de Dunkerque, 59240 Dunkerque, France.
authors: Olivier
authors: O
authors: Tricot
authors: CHRU de Lille, 59037 Lille, France; Faculté de médecine de Lille, 59045 Lille, France.
authors: Gilles
authors: G
authors: Lemesle
authors: CHRU de Lille, 59037 Lille, France.
authors: Michel
authors: M
authors: Deneve
authors: CHRU de Lille, 59037 Lille, France; Inserm U1167, Institut Pasteur de Lille, université Lille Nord de France, 59000 Lille, France.
authors: Pascal
authors: P
authors: de Groote
authors: CHRU de Lille, 59037 Lille, France; Inserm U1167, Institut Pasteur de Lille, université Lille Nord de France, 59000 Lille, France; Faculté de médecine de Lille, 59045 Lille, France. Electronic address: christophe.bauters@chru-lille.fr.
authors: Christophe
authors: C
authors: Bauters
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D015995:Prevalence; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D055502:Secondary Prevention / Q000379:methods*; D013318:Stroke Volume; D013599:Systole; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D016277:Ventricular Function, Left
keywords: Coronary artery disease; Ejection fraction; Fraction d’éjection; Maladie coronaire; Prognosis; Pronostic