Key result
In patients with left ventricular systolic dysfunction and coronary perfusion pressure ≤42 mmHg, reasonable incomplete revascularization was associated with a significantly higher mortality risk than complete revascularization (HR 2.39).
Why the study?
Coronary perfusion pressure (CPP) and coronary artery stenosis govern myocardial perfusion, but how CPP-related survival affects revascularization in left ventricular systolic dysfunction remains unclear.
Does reasonable incomplete revascularization compared to complete revascularization affect all-cause mortality in patients with left ventricular systolic dysfunction undergoing PCI, and is this modified by baseline coronary perfusion pressure?
Cohort (n=816)
No
Does reasonable incomplete revascularization compared to complete revascularization affect all-cause mortality in patients with left ventricular systolic dysfunction undergoing PCI, and is this modified by baseline coronary perfusion pressure?
Hazard Ratio: 2.39 (95% CI 1.27–4.5)
Absolute Event Rate: 29.7% vs 13.9%
p-value: p=0.007
In patients with left ventricular systolic dysfunction undergoing PCI, complete revascularization is crucial for survival when coronary perfusion pressure is ≤42 mmHg, whereas reasonable incomplete revascularization yields equivalent survival when CPP is >42 mmHg.
May support preferring complete revascularization in LVSD with CPP ≤42 mmHg; leaves open causal benefit pending randomized trials.
Background Coronary perfusion pressure (CPP) and coronary artery stenosis are responsible for myocardial perfusion. However, how CPP-related survival outcome affects revascularization is unclear. Objective The aim of this study is to investigate the prognostic role of CPP in patients with left ventricular systolic dysfunction (LVSD) undergoing percutaneous coronary intervention (PCI) with complete revascularization (CR) or reasonable incomplete revascularization (RIR). Methods We retrospectively screened 6,076 consecutive patients in a registry. The residual synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) score (rSS) was used to define CR (rSS = 0) and RIR (0<rSS≤8). Propensity score matching was performed to reduce bias between RIR and CR. The primary endpoint was all-cause mortality. Results In total, 816 patients with LVSD who underwent CR or RIR were enrolled. After a mean follow-up of 4.6 years, 134 patients died. Both CPP and RIR independently predicted mortality in the total population. After 1:1 matching, 175 pairs of RIR and CR were found in patients with CPP > 42 mmHg. Moreover, 101 pairs of RIR and CR were present in patients with CPP ≤ 42 mmHg. In patients with CPP > 42 mmHg, RIR was not significantly different from CR in long-term mortality [hazard ratio (HR) 1.20; 95% confidence interval (CI):0.70–2.07; p = 0.513]; However, in patients with CPP≤42 mmHg, RIR had a significantly higher mortality risk than CR (HR 2.39; 95% CI: 1.27–4.50; p = 0.007). Conclusions The CPP had a risk stratification role in selecting different revascularization strategies in patients with LVSD. When patients with LVSD had CPP > 42 mmHg, RIR was equivalent to CR in survival. However, when patients with LVSD had CPP ≤ 42 mmHg, RIR had a significantly higher mortality risk than CR.
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Hsieh et al. (2022) conducted a cohort in Left ventricular systolic dysfunction (LVSD) (n=816). Reasonable incomplete revascularization (RIR) vs. Complete revascularization (CR) was evaluated on All-cause mortality (HR 2.39, 95% CI 1.27-4.50, p=0.007). In patients with left ventricular systolic dysfunction and coronary perfusion pressure ≤42 mmHg, reasonable incomplete revascularization was associated with a significantly higher mortality risk than complete revascularization (HR 2.39).
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