Long-term outcomes and predictors of mortality in patients with chronic ischemic left ventricular dysfunction undergoing PCI: A multicenter study

BACKGROUND: Patients with chronic ischemic left ventricular (LV) dysfunction represent a high-risk population. While percutaneous coronary intervention (PCI) is commonly performed in this setting, long-term outcome data and predictors of adverse events are limited. OBJECTIVE: To analyse patients with chronic ischemic LV dysfunction who underwent PCI and evaluate predictors of all-cause mortality and myocardial infarction (MI). METHODS: We performed a retrospective, multicenter, observational study including consecutive patients (2016-2022) from three Italian hub hospitals who underwent PCI with LV ejection fraction (LVEF) < 50 % due to chronic ischemic disease. RESULTS: 279 patients were included; median age 71 (IQR 64-78) years, 76.7 % male, 46.2 % diabetic, 26.2 % with chronic kidney disease (CKD) and 33.0 % with prior MI. Median LVEF was 35 % (28-40). Over a median follow-up of 53 (36-73) months, death and MI occurred in 33.7 % of the patients. Multiple Cox regression identified baseline NYHA class (HR 1.54, 95 % CI 1.15-2.06, p = 0.004) and CKD (HR 1.91, 95 % CI 1.24-2.95, p = 0.003) as independent predictors of death or MI. IPTW Adjusted Cox proportional hazard models showed that complete revascularization (HR 0.57, 95 %CI 0.32-0.99, p = 0.047), and PCI of LAD (HR 0.52, 95 %CI 0.33-0.81, p = 0.004), were independent predictors of death and MI. CONCLUSIONS: In this multicenter real-world cohort, heart failure severity and comorbidities adversely affected prognosis, while complete revascularization and PCI of the LAD were associated with reduced risk of death and MI. These findings underscore the importance of careful patient profiling as well as the importance of the revascularization to optimize prognosis in this high-risk population.