Key result
Decline from preserved to impaired LVEF following elective PCI was associated with an increased 5-year risk for all-cause mortality and acute myocardial infarction (HR 2.79, P<0.001).
Why the study?
Do dynamic changes in left ventricular ejection fraction (LVEF) after elective PCI predict long-term mortality and acute myocardial infarction?
Cohort (n=974)
No
Do dynamic changes in left ventricular ejection fraction (LVEF) after elective PCI predict long-term mortality and acute myocardial infarction?
Hazard Ratio: 2.79
p-value: p=<0.001
Dynamic changes in LVEF after elective PCI are common and strongly predict long-term clinical outcomes, emphasizing the prognostic value of follow-up echocardiography.
LVEF decline after elective PCI identifies higher-risk patients; hypothesis-generating and requires prospective validation before guiding practice.
OBJECTIVES: To estimate the prevalence, identify predictors, and assess the prognostic implications of left ventricular ejection fraction (LVEF) changes after an elective percutaneous coronary intervention (PCI). METHODS: We included all consecutive patients who underwent elective PCI in our institution and were evaluated with echocardiography before and within 1 year of the procedure. Patients were grouped in terms of baseline LVEF. Hazard ratios (HRs) for all-cause mortality and acute myocardial infarction were calculated for baseline LVEF groups and in terms of LVEF normalization or decline. RESULTS: A total of 974 patients were included. Patients with moderately impaired (HR 1.41, P=0.01) and poor LVEF (HR 2.44, P<0.001) had significantly worse survival in comparison with patients with good LVEF. Decline from preserved to impaired LVEF following PCI was associated with an increased 1-year risk (HR 3.48, P<0.001) and 5-year risk (HR 2.79, P<0.001) for the composite outcome of all-cause mortality and acute myocardial infarction. LVEF recovery from impaired to preserved was associated with a decreased 5-year risk for the composite outcome (HR 0.5, P<0.001). CONCLUSION: Changes in LVEF after elective PCI occur often. Both higher baseline LVEF and post-PCI LVEF normalization are associated with improved outcomes.
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Levi et al. (2016) conducted a cohort in Elective percutaneous coronary intervention (PCI) (n=974). Decline from preserved to impaired LVEF vs. Maintained preserved LVEF was evaluated on Composite of all-cause mortality and acute myocardial infarction (HR 2.79, p=<0.001). Decline from preserved to impaired LVEF following elective PCI was associated with an increased 5-year risk for all-cause mortality and acute myocardial infarction (HR 2.79, P<0.001).
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