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Observational Study
. 2024 Nov 5;13(21):e035791.
doi: 10.1161/JAHA.124.035791. Epub 2024 Oct 18.

Left Ventricular Ejection Fraction Change Following Percutaneous Coronary Intervention: Correlates and Association With Prognosis

Gjin Ndrepepa  1 , Salvatore Cassese  1 , Robert A Byrne  2   3 , Blerina Bevapi  1 , Michael Joner  1   4 , Hendrik B Sager  1   4 , Sebastian Kufner  1   4 , Erion Xhepa  1 , Tareq Ibrahim  5 , Karl-Ludwig Laugwitz  4   5 , Heribert Schunkert  1   4 , Adnan Kastrati  1   4
Affiliations
Observational Study

Left Ventricular Ejection Fraction Change Following Percutaneous Coronary Intervention: Correlates and Association With Prognosis

Gjin Ndrepepa et al. J Am Heart Assoc. .

Abstract

Background: The association between left ventricular ejection fraction (LVEF) change (ΔLVEF) following percutaneous coronary intervention (PCI) and the long-term mortality rate in patients with coronary artery disease is incompletely investigated. We aimed to assess the impact of PCI on LVEF and the association of ΔLVEF after PCI with the long-term mortality rate.

Methods and results: This observational study included 8181 patients with paired angiographic LVEF measurements performed at baseline and 6 to 8 months following the index PCI. ΔLVEF was defined as LVEF measured on the 6- to 8-month angiography minus LVEF measured on the baseline angiography. LVEF change was classified according to the following categories: reduced (ΔLVEF <0), mildly improved (ΔLVEF >0% to <10%) and largely improved (ΔLVEF ≥10%). The primary outcome was the 5-year mortality rate. In patients with baseline LVEF <40%, 40% to <50% and ≥50%, ΔLVEF (median [25th-75th percentiles]) was 6.0% [0.0% to 14.0%], 4.0% [-1.0% to 11.0%] and 0.0% [-4.0% to 3.0%], respectively (P<0.001). In patients with reduced, mildly improved, and largely improved ΔLVEF, the 5-year mortality rate (n=712) was 29.1%, 23.1%, and 16.5%, respectively, in patients with baseline LVEF <40%; 17.0%, 12.2% and 9.8%, respectively, in patients with baseline LVEF 40% to <50%; and 7.8%, 7.1%, and 5.6%, respectively, in patients with baseline LVEF ≥50% (adjusted hazard ratio [HR], 0.91 [95% CI, 0.86-0.96]; P<0.001) for all-cause death and adjusted (HR, 0.86 [95% CI, 0.81-0.92]; P<0.001) for cardiac death, calculated for 5% higher ΔLVEF.

Conclusions: In patients with coronary artery disease undergoing PCI, improvement of LVEF following PCI was associated with a reduced long-term mortality rate in patients with reduced LVEF but not in patients with preserved LVEF before intervention.

Keywords: coronary artery disease; death; left ventricular ejection fraction; percutaneous coronary intervention.

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Figures

Figure 1
Figure 1. Change in the left ventricular ejection fraction (ΔLVEF) from baseline to 6‐ to 8‐month angiography according to categories of baseline LVEF.
Data are median with 25th to 75th percentiles. LVEF indicates left ventricular ejection fraction.
Figure 2
Figure 2. Kaplan–Meier curves of all‐cause death according to categories of baseline LVEF.
The time point 0 in the time scale represents the time of 6–8 months angiography. HR indicates hazard ratio; and LVEF, left ventricular ejection fraction
Figure 3
Figure 3. Kaplan–Meier curves of cardiac death according to categories of baseline LVEF.
The time point 0 in the time scale represents the time of 6‐ to 8‐month angiography. HR indicates hazard ratio; and LVEF, left ventricular ejection fraction.
Figure 4
Figure 4. Restricted cubic spline regression showing the association between ΔLVEF following PCI and all‐cause death.
Spline curve shows the risk of mortality for ΔLVEF values between −40.0% and 40.0%. For ΔLVEF values less than −9.0%, the risk for 5‐year death was significant. The inserted table on the right side shows the HRs with 95% (CIs) for all‐cause death at different values of ΔLVEF. HR indicates hazard ratio; ΔLVEF, left ventricular ejection fraction change; and PCI, percutaneous coronary intervention.
Figure 5
Figure 5. Restricted cubic spline regression showing the association between lΔLVEF following PCI and cardiac death.
Spline curve shows the risk of cardiac mortality for ΔLVEF values between −40.0% and 40.0%. For ΔLVEF values <−9.5%, the risk for 5‐year cardiac death was significant. The inserted table on the right side shows the HRs with 95% CIs for cardiac death at different values of ΔLVEF. HR indicates hazard ratio; ΔLVEF, left ventricular ejection fraction change; and PCI, percutaneous coronary intervention.
See this image and copyright information in PMC

References

    1. Siontis GC, Branca M, Serruys P, Silber S, Raber L, Pilgrim T, Valgimigli M, Heg D, Windecker S, Hunziker L. Impact of left ventricular function on clinical outcomes among patients with coronary artery disease. Eur J Prev Cardiol. 2019;26:1273–1284. doi: 10.1177/2047487319841939 - DOI - PubMed
    1. Mamas MA, Anderson SG, O'Kane PD, Keavney B, Nolan J, Oldroyd KG, Perera D, Redwood S, Zaman A, Ludman PF, et al. Impact of left ventricular function in relation to procedural outcomes following percutaneous coronary intervention: insights from the british cardiovascular intervention society. Eur Heart J. 2014;35:3004–3012a. doi: 10.1093/eurheartj/ehu303 - DOI - PubMed
    1. Velagaleti RS, Vetter J, Parker R, Kurgansky KE, Sun YV, Djousse L, Gaziano JM, Gagnon D, Joseph J. Change in left ventricular ejection fraction with coronary artery revascularization and subsequent risk for adverse cardiovascular outcomes. Circ Cardiovasc Interv. 2022;15:e011284. doi: 10.1161/CIRCINTERVENTIONS.121.011284 - DOI - PMC - PubMed
    1. Jedrzkiewicz S, Goodman SG, Yan RT, Grondin FR, Gallo R, Welsh RC, Lai K, Huynh T, Yan AT; Canadian Acute Coronary Syndrome I and II Registries , et al. Evaluation of left ventricular ejection fraction in non‐st‐segment elevation acute coronary syndromes and its relationship to treatment. Am Heart J. 2010;159:605–611. doi: 10.1016/j.ahj.2010.01.014 - DOI - PubMed
    1. Miller AL, Dib C, Li L, Chen AY, Amsterdam E, Funk M, Saucedo JF, Wang TY. Left ventricular ejection fraction assessment among patients with acute myocardial infarction and its association with hospital quality of care and evidence‐based therapy use. Circ Cardiovasc Qual Outcomes. 2012;5:662–671. doi: 10.1161/CIRCOUTCOMES.112.965012 - DOI - PubMed

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