What is the clinical evidence from this study?

Study design: Observational. Population: Percutaneous coronary intervention (n=246840). Intervention: Poor left ventricular function vs. Preserved left ventricular function. Primary outcome: 30-day mortality (OR 4.50 to 5.65, 95% CI 3.64-7.58).

November 19, 2014

Impact of age on the prognostic value of left ventricular function in relation to procedural outcomes following percutaneous coronary intervention: Insights from the British cardiovascular intervention society

Key Result

Poor left ventricular function was independently associated with an increased risk of 30-day mortality across all age groups undergoing PCI (e.g., OR 5.65; 95% CI 4.21-7.58 for age <60 years).

Study Design

Type

Observational (n=246,840)

Multicenter

Yes

Structured PICO

Does poor left ventricular function predict 30-day mortality in patients undergoing PCI across different age groups?

Population

246,840 patients undergoing percutaneous coronary intervention (PCI) in the UK between 2006 and 2011, stratified by age groups (<60 years, 60 to <70 years, 70 to <80 years, and ≥80 years).

Intervention

Poor left ventricular (LV) function

Comparator

Normal or better left ventricular function

Outcome

30-day mortalityhard clinical

Worsening left ventricular function is a strong, independent predictor of 30-day mortality following PCI across all age groups, highlighting the importance of LV function assessment for risk stratification.

Main Result

Effect estimate: OR 4.50 to 5.65 (95% CI 3.64-7.58)

Abstract

BACKGROUND: Around one third of patients undergoing percutaneous coronary intervention (PCI) have left ventricular (LV) dysfunction. Whilst the prevalence of LV dysfunction is known to increase with age, the prevalence of LV dysfunction in different age groups in the PCI setting is not known and the effect of age on the prognostic value of LV function in the PCI setting has not been examined. METHODS: The relationship between LV function and 30-day mortality in patients undergoing PCI in different age groups (<60 years, 60 to <70 years, 70 to <80 years and ≥80 years) was studied in 246,840 patients in the UK between 2006 and 2011. RESULTS: Prevalent LV dysfunction in patients undergoing PCI increased with age; 25,106/83,161 (30.2%: <60 years), 24,114/76,895 (31.4%: 60 to <70 years), 23,580/64,711 36.4% (70 to <80 years) and 9,851/22,073 (44.6%) in patients aged 80 or over (P < 0.0001). Poor LV function was independently associated with increased risk of 30-day mortality outcomes in all age groups (OR 5.65:95% CI 4.21-7.58, age <60 years; OR 5.07: 95% CI 3.91-6.57, age 60 to <70 years; OR 4.50: 95% CI 3.64-5.57, 70 to <80 years and OR 4.83:95% CI 3.79-6.15, age ≥80 years). CONCLUSIONS: Our analysis suggests that worsening LV function is an important independent predictor of worse 30-day mortality outcomes across all age groups and underscores the need for a measure of LV function in all patients for accurate risk stratification prior to PCI.

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