CLEVELAND — While revascularization of ischemic cardiomyopathy by coronary artery bypass grafting has been shown to improve survival among patients with left ventricular ejection fraction (LVEF) ≤35%, the role of percutaneous coronary intervention (PCI) in this context is less understood, according to a new study.
A study team from the Cleveland Clinic, the Rocky Mountain Regional VA Medical Center in Aurora, CO, and Duke University School of Medicine in Durham, NC, sought to evaluate the effect of PCI on mortality and hospitalization among patients with stable coronary artery disease and reduced left ventricular ejection fraction.
To do that, researchers performed a retrospective analysis comparing PCI with medical therapy among patients with ischemic cardiomyopathy in the VHA. Patients with angiographic evidence of one or more epicardial stenoses amenable to PCI and LVEF ≤35% were included in the analysis. VA and non-VA data sources on mortality and hospital admission were used to determine outcome data, which were published in the American Heart Journal.1
The study identified a sample of 4,628 patients from 2008 through 2015, and 1,322 underwent ad hoc PCI. With maximum followup of three years, propensity score weighted landmark analysis was used to evaluate the primary and secondary outcomes.
Results indicated the primary outcome of all-cause mortality was significantly lower in the PCI cohort compared with medical therapy (21.6% vs. 30.0%, P <0.001). Researchers reported that the secondary outcome of all-cause rehospitalization or death was also lower in the PCI cohort (76.5% vs. 83.8%, P <0.001).
“In this retrospective analysis of patients with ischemic cardiomyopathy with coronary artery disease amenable to PCI and LVEF ≤35%, revascularization by PCI was associated with decreased all-cause mortality and decreased all-cause death or rehospitalization,” the authors concluded.
- Brophy TJ, Warsavage TJ, Hebbe AL, Plomondon ME, et. Al. Percutaneous Coronary Intervention in Patients with Stable Coronary Artery Disease and Left Ventricular Systolic Dysfunction: Insights from the VA CART Program. Am Heart J. 2021 Feb 7:S0002-8703(21)00034-X. doi: 10.1016/j.ahj.2021.02.002. Epub ahead of print. PMID: 33567318.