Ejection fraction outcome after percutaneous coronary intervention in patients with severe left ventricular dysfunction

Background:
Coronary revascularization in high-risk patients, such as those wit left ventricular ejection fraction dysfunction remains nowadays as a clinical challenge. Recent studies have shown that surgical revascularization may have an impact in ventricular sizing. This hasn´t been evaluated in patients undergoing percutaneous coronary intervention. Objective: To evaluate left ventricular ejection fraction improvement after PCI in patients with multivessel disease and severe left ventricular dysfunction.

Methods:
From 2001 to June 2018, 3512 PCI were done. After excluding patients with prior CABG, cardiogenic shock, ST elevated myocardial infarction and epiphenomenon; and including multi-vessel disease, we conformed a group of 153 patients to analyze. Baseline characteristics were, n (%) respectively: Age 65.8±10.9; male 126 (82); diabetes 64 (42); hypertension 126 (82); smoking 115 (75); chronic kidney disease 19 (12); chronic obstructive pulmonary disease 13 (8); prior acute myocardial infarction 78 (51); prior PCI 51 (33); baseline EF% 32±7.3; UANSTEMI 73 (48); 2 vessel disease 106 (69); 3 vessel 47 (31); complete revascularization 36 (24); left main 7 (5); LAD 92 (60); radial 77 (50); stent number avg 2.3±1.6; stent length mm 51±37.1; at least one DES 95 (62); fluoro min 20.3±13.6; contrast ml 215.4±83.8.

Results:
Technical success 144 (94); clinical success 137 (90); cardiac death 6 (4); early coronary occlussion 5 (3); stroke 0; vascular complication 1 (1); follow up 38.2±31.5; EF% at follow up 40.4±11.9 (p<0.05); extra hospital cardiac death 3 (2); reintervention 23 (15); CABG 6 (4); re PCI 17 (11); TLR 5 (3).

Conclusions:
In patients with severe left ventricular dysfunction and multi-vessel disease, we found a significant improvement in ventricular function after PCI.