Percutaneous coronary intervention outcomes in patients with stable coronary disease and left ventricular systolic dysfunction

ESC Heart Failure

Mitchell W. Krucoff¹  Adam D. DeVore¹  Erik Magnus Ohman¹  Eric Yow²  Linda K. Shaw²  Karen Chiswell²  Christopher M. O'Connor³  Matthew W. Sherwood³  Eric J. Velazquez⁴ 

[1] Department of Medicine Duke University School of Medicine Durham NC USA;Duke Clinical Research Institute Duke University School of Medicine 200 Morris Street, 6318 Durham NC 27701 USA;Inova Heart and Vascular Institute Falls Church VA USA;Yale University School of Medicine New Haven CT USA;

关键词: Coronary artery disease;    Left ventricular dysfunction;    Heart failure;    Outcomes;   

DOI  :  10.1002/ehf2.12510

来源: DOAJ

【 摘 要 】

Abstract Aims We sought to better understand the role of percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD) and moderate or severe left ventricular systolic dysfunction. Methods and results Using data from the Duke Databank for Cardiovascular Disease, we analysed patients who underwent coronary angiography at Duke University Medical Center (1995–2012) that had stable CAD amenable to PCI and left ventricular ejection fraction ≤35%. Patients with acute coronary syndrome or Canadian Cardiovascular Society class III or IV angina were excluded. We used propensity‐matched Cox proportional hazards to evaluate the association of PCI with mortality and hospitalizations. Of 901 patients, 259 were treated with PCI and 642 with medical therapy. PCI propensity scores created from 24 variables were used to assemble a matched cohort of 444 patients (222 pairs) receiving PCI or medical therapy alone. Over a median follow‐up of 7 years, 128 (58%) PCI and 125 (56%) medical therapy alone patients died [hazard ratio 0.87 (95% confidence interval 0.68, 1.10)]; there was also no difference in the rate of a composite endpoint of all‐cause mortality or cardiovascular hospitalization [hazard ratio 1.18 (95% confidence interval 0.96, 1.44)] between the two groups. Conclusions In this well‐profiled, propensity‐matched cohort of patients with stable CAD amenable to PCI and moderate or severe left ventricular systolic dysfunction, the addition of PCI to medical therapy did not improve long‐term mortality, or the composite of mortality or cardiovascular hospitalization. The impact of PCI on other outcomes in these high‐risk patients requires further study.

【 授权许可】

Unknown