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Observational Study
. 2023 Jan 1;24(1):23-35.
doi: 10.2459/JCM.0000000000001383. Epub 2022 Oct 11.

Impact of left ventricular ejection fraction on outcomes after left main revascularization: g-LM Registry

Amin Daoulah  1 , Maryam Jameel Naser  2 , Ahmad S Hersi  3 , Mohammed Alshehri  4 , Turki Al Garni  5 , Reda Abuelatta  6 , Nooraldaem Yousif  7 , Wael Almahmeed  8 , Abdulaziz Alasmari  1 , Alwaleed Aljohar  3 , Badr Alzahrani  5 , Bader K Abumelha  9 , Mohamed Ajaz Ghani  6 , Haitham Amin  7 , Shahrukh Hashmani  8 , Niranjan Hiremath  8 , Hameedullah M Kazim  10 , Wael Refaat  11 , Ehab Selim  10 , Ahmed Jamjoom  1 , Osama El-Sayed  1 , Salem M Al-Faifi  12 , Maun N Feteih  12 , Ziad Dahdouh  13 , Jairam Aithal  14 , Ahmed M Ibrahim  15 , Abdelmaksoud Elganady  16 , Mohammed A Qutub  17 , Mohamed N Alama  17 , Abdulwali Abohasan  18 , Taher Hassan  19 , Mohammed Balghith  20 , Adnan Fathey Hussien  21 , Ibrahim A M Abdulhabeeb  22 , Osama Ahmad  13 , Mohamed Ramadan  11 , Abdulrahman H Alqahtani  23 , Saif S Alshahrani  24 , Wael Qenawi  4 , Ahmed Shawky  4 , Ahmed A Ghonim  17 , Ahmed Elmahrouk  1   25 , Sameer Alhamid  26 , Mohamed Maghrabi  10 , Mamdouh M Haddara  27 , Mina Iskandar  28 , Abeer M Shawky  16 , William T Hurley  29 , Youssef Elmahrouk  30 , Waleed A Ahmed  31 , Amir Lotfi  32
Affiliations
Observational Study

Impact of left ventricular ejection fraction on outcomes after left main revascularization: g-LM Registry

Amin Daoulah et al. J Cardiovasc Med (Hagerstown). .

Abstract

Aims: The impact of left ventricular dysfunction on clinical outcomes following revascularization is not well established in patients with unprotected left main coronary artery disease (ULMCA). In this study, we evaluated the impact of left ventricular ejection fraction (LVEF) on clinical outcomes of patients with ULMCA requiring revascularization with percutaneous coronary intervention (PCI) compared with coronary artery bypass graft (CABG).

Methods: The details of the design, methods, end points, and relevant definitions are outlined in the Gulf Left Main Registry: a retrospective, observational study conducted between January 2015 and December 2019 across 14 centres in 3 Gulf countries. In this study, the data on patients with ULMCA who underwent revascularization through PCI or CABG were stratified by LVEF into three main subgroups; low (l-LVEF <40%), mid-range (m-LVEF 40-49%), and preserved (p-LVEF ≥50%). Primary outcomes were hospital major adverse cardiovascular and cerebrovascular events (MACCE) and mortality and follow-up MACCE and mortality.

Results: A total of 2137 patients were included; 1221 underwent PCI and 916 had CABG. During hospitalization, MACCE was significantly higher in patients with l-LVEF [(10.10%), P = 0.005] and m-LVEF [(10.80%), P = 0.009], whereas total mortality was higher in patients with m-LVEF [(7.40%), P = 0.009] and p-LVEF [(7.10%), P = 0.045] who underwent CABG. There was no mortality difference between groups in patients with l-LVEF. At a median follow-up of 15 months, there was no difference in MACCE and total mortality between patients who underwent CABG or PCI with p-LVEF and m-LVEF.

Conclusion: CABG was associated with higher in-hospital events. Hospital mortality in patients with l-LVEF was comparable between CABG and PCI. At 15 months' follow-up, PCI could have an advantage in decreasing MACCE in patients with l-LVEF.

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