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)≤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 β-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≤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.

Keywords: Coronary stent, Left ventricular systolic dysfunction, Outcome