Determinants of outcome in patients with chronic ischemic left ventricular dysfunction undergone percutaneous coronary interventions

BMC Cardiovascular Disorders

Research Article

Francesco Arioli¹  Ornella E. Rimoldi²  Isabella Scotti³  Valentina Guida⁴  Paolo G. Camici⁴  Azeem Latib⁴  Francesco Moroni⁴  Enrico Ammirati⁵  Antonio Colombo⁶ 

[1] A.O. Ospedale di Circolo di Busto Arsizio, Busto Arsizio, VA, Italy;CNR Institute of Clinical Physiology, Milan, Italy;Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy;IRCCS Ospedale San Raffaele and Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy;IRCCS Ospedale San Raffaele and Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy;Azienda Ospedaliera Ospedale Niguarda Ca’ Granda, Milan, Italy;Cardiothoracic Department, San Raffaele Scientific Institute and University, Via Olgettina 60, 20132, Milan,, Italy;IRCCS Ospedale San Raffaele and Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy;EMO-GVM Centro Cuore Columbus, Milan, Italy;

关键词: Coronary artery disease;    Ischemic systolic left ventricular dysfunction;    Heart failure;    Coronary revascularization;    Percutaneous coronary intervention;    stress testing;   

DOI  :  10.1186/s12872-015-0126-x

 received in 2015-07-06, accepted in 2015-10-16,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundPercutaneous coronary interventions (PCI) in patients with ischemic systolic left ventricular dysfunction (SLVD) are routinely performed although their impact on prognosis remains unclear.MethodsWe retrospectively evaluated 385 consecutive patients (76 % male, 66 ± 9 years) with SLVD (left ventricular ejection fraction [LVEF] ≤40 %) due to chronic coronary artery disease, who underwent PCI between 1999 and 2009, and explored clinical factors associated with higher risk of death or of a composite of death and hospitalization for acute decompensated heart failure (ADHF).ResultsThe median follow-up was 28 months (inter-quartile range 14–46 months). Death and the composite outcome of death and hospitalization for ADHF occurred in 80 (21 %) and 109 (28 %) patients respectively (8.4 and 11.5 per 100 patient-years of follow-up). Insulin-dependent diabetes mellitus (IDDM), multivessel disease, LVEF < 35 %, symptoms of heart failure (HF) emerged both as independent predictors of death (adjusted hazard ratios [HR] 2.64; 1.92, 1.88 and 1.67 respectively) and composite outcome of death and hospitalization for ADHF (adjusted HR 2.22, 1.92, 1.79 and 1.94 respectively). Furthermore advanced age (HR = 1.03) emerged as independent predictors of death and having performed a stress test before PCI correlated with reduced number of deaths and ADHF hospitalizations (HR = 0.60). Of note, PCI significantly reduced the symptom of angina from 63.2 % at baseline to 16.3 % at the last follow up (p < 0.0001).ConclusionsIDDM, symptoms of HF, multivessel disease and LVEF < 35 % appear to be associated with worse outcome patients with ischemic SLVD undergoing PCI, and may be taken into account for optimal risk stratification. On the other hand, performing a stress testing before PCI seems to be associated with a more favorable outcome.

【 授权许可】

CC BY   
© Ammirati et al. 2015