Percutaneous coronary intervention outcomes in patients with stable coronary disease and left ventricular systolic dysfunction.

Published

Journal Article

AIMS: We sought to better understand the role of percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD) and moderate or severe left ventricular systolic dysfunction. METHODS AND RESULTS: Using data from the Duke Databank for Cardiovascular Disease, we analysed patients who underwent coronary angiography at Duke University Medical Center (1995-2012) that had stable CAD amenable to PCI and left ventricular ejection fraction ≤35%. Patients with acute coronary syndrome or Canadian Cardiovascular Society class III or IV angina were excluded. We used propensity-matched Cox proportional hazards to evaluate the association of PCI with mortality and hospitalizations. Of 901 patients, 259 were treated with PCI and 642 with medical therapy. PCI propensity scores created from 24 variables were used to assemble a matched cohort of 444 patients (222 pairs) receiving PCI or medical therapy alone. Over a median follow-up of 7 years, 128 (58%) PCI and 125 (56%) medical therapy alone patients died [hazard ratio 0.87 (95% confidence interval 0.68, 1.10)]; there was also no difference in the rate of a composite endpoint of all-cause mortality or cardiovascular hospitalization [hazard ratio 1.18 (95% confidence interval 0.96, 1.44)] between the two groups. CONCLUSIONS: In this well-profiled, propensity-matched cohort of patients with stable CAD amenable to PCI and moderate or severe left ventricular systolic dysfunction, the addition of PCI to medical therapy did not improve long-term mortality, or the composite of mortality or cardiovascular hospitalization. The impact of PCI on other outcomes in these high-risk patients requires further study.

Full Text

Duke Authors

Cited Authors

  • DeVore, AD; Yow, E; Krucoff, MW; Sherwood, MW; Shaw, LK; Chiswell, K; O'Connor, CM; Ohman, EM; Velazquez, EJ

Published Date

  • December 2019

Published In

Volume / Issue

  • 6 / 6

Start / End Page

  • 1233 - 1242

PubMed ID

  • 31560171

Pubmed Central ID

  • 31560171

Electronic International Standard Serial Number (EISSN)

  • 2055-5822

Digital Object Identifier (DOI)

  • 10.1002/ehf2.12510

Language

  • eng

Conference Location

  • England