European heart journal · 2014
Impact of left ventricular function in relation to procedural outcomes following percutaneous coronary intervention: insights from the British Cardiovascular Intervention Society.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Mamas Mamas A, Anderson Simon G, O'Kane Peter D, Keavney Bernard, Nolan James, Oldroyd Keith G, Perera Divaka, Redwood Simon, Zaman Azfar, Ludman Peter F, de Belder Mark A, British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research
Аннотация
AIM: Between 10 and 30% of patients undergoing percutaneous coronary intervention (PCI) have left ventricular (LV) dysfunction. We investigate the association between LV function on early and late mortality outcomes in a national 'real-world' cohort undergoing PCI in the elective and acute coronary syndrome setting through analysis of the British Cardiovascular Intervention Society (BCIS) data set.
METHODS AND RESULTS: The relationship between LV function and 30-day mortality in patients undergoing PCI for elective, ST-elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) indications was studied in 230 464 patients in the UK between 2006 and 2011. Abnormal LV function was an independent predictor of 30-day mortality outcomes: 30-day mortality risk for patients with moderate LV function (EF: 30-49%) (HR: 2.91; 95% CI: 2.43-3.49, P < 0.0001) and poor LV function (EF <30%) (HR: 7.25; 95% CI: 5.87-8.96, P < 0.0001) was compared with patients with good LV function (EF >50%). The independent prognostic impact of poor LV function on 30-day mortality increased from elective PCI (HR: 3.72: 95% CI: 2.21-6.25, P < 0.0001) through to the NSTEMI (HR: 5.03: 95% CI: 3.64-6.93, P < 0.0001) and STEMI (HR: 8.18: 95% CI: 5.62-11.92, P < 0.0001).
CONCLUSIONS: Our data suggest a strong relationship between LV function and mortality outcomes following PCI, with worsening LV function independently predicting 30-day and longer-term mortality outcomes across all indications for PCI. We report a differential impact of LV function on mortality outcomes across different indications for PCI, with the greatest adverse prognostic association between worsening LV function and mortality outcomes observed in patients undergoing PCI in the STEMI setting.
METHODS AND RESULTS: The relationship between LV function and 30-day mortality in patients undergoing PCI for elective, ST-elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) indications was studied in 230 464 patients in the UK between 2006 and 2011. Abnormal LV function was an independent predictor of 30-day mortality outcomes: 30-day mortality risk for patients with moderate LV function (EF: 30-49%) (HR: 2.91; 95% CI: 2.43-3.49, P < 0.0001) and poor LV function (EF <30%) (HR: 7.25; 95% CI: 5.87-8.96, P < 0.0001) was compared with patients with good LV function (EF >50%). The independent prognostic impact of poor LV function on 30-day mortality increased from elective PCI (HR: 3.72: 95% CI: 2.21-6.25, P < 0.0001) through to the NSTEMI (HR: 5.03: 95% CI: 3.64-6.93, P < 0.0001) and STEMI (HR: 8.18: 95% CI: 5.62-11.92, P < 0.0001).
CONCLUSIONS: Our data suggest a strong relationship between LV function and mortality outcomes following PCI, with worsening LV function independently predicting 30-day and longer-term mortality outcomes across all indications for PCI. We report a differential impact of LV function on mortality outcomes across different indications for PCI, with the greatest adverse prognostic association between worsening LV function and mortality outcomes observed in patients undergoing PCI in the STEMI setting.