Comparison of in-hospital and one-year outcomes in patients with left ventricular ejection fractions ≤40%, 41% to 49%, and ≥50% having percutaneous coronary revascularization

Paul C. Keelan, Janet M. Johnston, Tulay Koru-Sengul, Katherine M. Detre, David O. Williams, James Slater, Peter C. Block, David Holmes

Research output: Contribution to journalArticle

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Abstract

Outcome studies of percutaneous coronary intervention (PCI) with conventional balloon angioplasty have established increased in-hospital and 1-year mortality in patients with left ventricular (LV) dysfunction compared with others. It is unclear whether recent PCI practice innovations, including stents and adjunctive pharmacotherapy, have made PCI safer and more effective in patients with LV dysfunction. We evaluated the influence of LV ejection fraction (EF) indexes on in-hospital and 1-year outcomes in 1,458 patients within the National Heart, Lung, and Blood Institute-sponsored Dynamic Registry. Patients (n = 300) with acute myocardial infarction were excluded. The remaining 1,158 patients were subdivided into 3 categories: group 1, EF ≤40% (n = 166); group 2, EF 41% to 49% (n = 126); and group 3, EF ≥50% (n = 866). We determined the frequency of individual and composite adverse events (death/myocardial infarction [MI]/coronary artery bypass grafting) at discharge and 1 year. In the Dynamic Registry patients, mean EF in the 3 groups was 32%, 45%, and 62% and in-hospital mortality was 3.0%, 1.6%, and 0.1%, respectively (p <0.001). The composite end point of death/MI was also significant, but other in-hospital adverse events did not differ between groups. The respective mortality rates were 11.0%, 4.5%, and 1.9% (p <0.001) after 1 year. The composite end points of death/MI and death/MI/coronary artery bypass grafting also occurred more frequently in group 1 patients. Thus, significant LV dysfunction was still associated with increased in-hospital and 1-year mortality in patients having contemporary PCI.

Original languageEnglish (US)
Pages (from-to)1168-1172
Number of pages5
JournalAmerican Journal of Cardiology
Volume91
Issue number10
DOIs
StatePublished - May 15 2003

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Percutaneous Coronary Intervention
Stroke Volume
Myocardial Infarction
Left Ventricular Dysfunction
Coronary Artery Bypass
Registries
Mortality
National Heart, Lung, and Blood Institute (U.S.)
Balloon Angioplasty
Hospital Mortality
Stents
Outcome Assessment (Health Care)
Drug Therapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Comparison of in-hospital and one-year outcomes in patients with left ventricular ejection fractions ≤40%, 41% to 49%, and ≥50% having percutaneous coronary revascularization. / Keelan, Paul C.; Johnston, Janet M.; Koru-Sengul, Tulay; Detre, Katherine M.; Williams, David O.; Slater, James; Block, Peter C.; Holmes, David.

In: American Journal of Cardiology, Vol. 91, No. 10, 15.05.2003, p. 1168-1172.

Research output: Contribution to journalArticle

Keelan, Paul C. ; Johnston, Janet M. ; Koru-Sengul, Tulay ; Detre, Katherine M. ; Williams, David O. ; Slater, James ; Block, Peter C. ; Holmes, David. / Comparison of in-hospital and one-year outcomes in patients with left ventricular ejection fractions ≤40%, 41% to 49%, and ≥50% having percutaneous coronary revascularization. In: American Journal of Cardiology. 2003 ; Vol. 91, No. 10. pp. 1168-1172.
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abstract = "Outcome studies of percutaneous coronary intervention (PCI) with conventional balloon angioplasty have established increased in-hospital and 1-year mortality in patients with left ventricular (LV) dysfunction compared with others. It is unclear whether recent PCI practice innovations, including stents and adjunctive pharmacotherapy, have made PCI safer and more effective in patients with LV dysfunction. We evaluated the influence of LV ejection fraction (EF) indexes on in-hospital and 1-year outcomes in 1,458 patients within the National Heart, Lung, and Blood Institute-sponsored Dynamic Registry. Patients (n = 300) with acute myocardial infarction were excluded. The remaining 1,158 patients were subdivided into 3 categories: group 1, EF ≤40{\%} (n = 166); group 2, EF 41{\%} to 49{\%} (n = 126); and group 3, EF ≥50{\%} (n = 866). We determined the frequency of individual and composite adverse events (death/myocardial infarction [MI]/coronary artery bypass grafting) at discharge and 1 year. In the Dynamic Registry patients, mean EF in the 3 groups was 32{\%}, 45{\%}, and 62{\%} and in-hospital mortality was 3.0{\%}, 1.6{\%}, and 0.1{\%}, respectively (p <0.001). The composite end point of death/MI was also significant, but other in-hospital adverse events did not differ between groups. The respective mortality rates were 11.0{\%}, 4.5{\%}, and 1.9{\%} (p <0.001) after 1 year. The composite end points of death/MI and death/MI/coronary artery bypass grafting also occurred more frequently in group 1 patients. Thus, significant LV dysfunction was still associated with increased in-hospital and 1-year mortality in patients having contemporary PCI.",
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AU - Holmes, David

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AB - Outcome studies of percutaneous coronary intervention (PCI) with conventional balloon angioplasty have established increased in-hospital and 1-year mortality in patients with left ventricular (LV) dysfunction compared with others. It is unclear whether recent PCI practice innovations, including stents and adjunctive pharmacotherapy, have made PCI safer and more effective in patients with LV dysfunction. We evaluated the influence of LV ejection fraction (EF) indexes on in-hospital and 1-year outcomes in 1,458 patients within the National Heart, Lung, and Blood Institute-sponsored Dynamic Registry. Patients (n = 300) with acute myocardial infarction were excluded. The remaining 1,158 patients were subdivided into 3 categories: group 1, EF ≤40% (n = 166); group 2, EF 41% to 49% (n = 126); and group 3, EF ≥50% (n = 866). We determined the frequency of individual and composite adverse events (death/myocardial infarction [MI]/coronary artery bypass grafting) at discharge and 1 year. In the Dynamic Registry patients, mean EF in the 3 groups was 32%, 45%, and 62% and in-hospital mortality was 3.0%, 1.6%, and 0.1%, respectively (p <0.001). The composite end point of death/MI was also significant, but other in-hospital adverse events did not differ between groups. The respective mortality rates were 11.0%, 4.5%, and 1.9% (p <0.001) after 1 year. The composite end points of death/MI and death/MI/coronary artery bypass grafting also occurred more frequently in group 1 patients. Thus, significant LV dysfunction was still associated with increased in-hospital and 1-year mortality in patients having contemporary PCI.

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