Stent implantation in patients with severe left ventricular systolic dysfunction

Background: Patients with ischemic severe left ventricular (LV) dysfunction are at higher risk for death. We assessed the outcome following percutaneous coronary intervention (PCI) in patients with LV systolic dysfunction. Methods: From April 1993 to March 2004 337 consecutive patients with LV ejection fraction (LVEF) ≤ 35% underwent elective stent implantation at out Institutions. Results: The in-hospital course was uneventful in 322 (95.3%) patients. In-hospital death occurred in 5 patients (1.5%). At 2-year, 83 patients (24.6%) died (Non-surviving group), whereas 254 (75.4%) were alive (Surviving group). Sudden death occurred in 65% of cases. An acute myocardial infarction at follow-up occurred more often in the Non-surviving group (18% versus 5.4%; p = 0.001). An implantable cardioverter-defibrillator (ICD) was implanted in 6.7% of patients in the Non-surviving group versus 20.7% of the Surviving group (p = 0.005). LVEF significantly improved at follow-up only in the Surviving group (29 ± 6 to 35 ± 11; p <0.001), whereas remained unchanged in the Non-surviving group (27 ± 5 to 26 ± 7; p = 0.30).The independent predictors of death at follow-up were: acute myocardial infarction (hazard ratio = 4.94; 95% confidence interval = 2.53-9.64; p <0.001), use of β-blockers (HR = 0.34; 95% CI = 0.18-0.65; p = 0.001), ICD implantation (0.16 [95% CI = 0.05-0.51]; p = 0.002), LVEF <25% (HR = 2.16; 95% confidence interval 1.25-3.76; p = 0.006), and completeness of revascularization (HR = 0.29; 95% CI = 0.10-0.82; p = 0.020). Conclusions: PCI in patients with LVEF ≤ 35% is feasible and safe. Independent predictors of death at 2-year are occurrence of an acute myocardial infarction, treatment by beta blockers, ICD implantation, LVEF <25% and completeness of revascularization.