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Percutaneous coronary intervention among patients with left ventricular systolic dysfunction: a review and meta-analysis of 19 clinical studies

Lookup NU author(s): Dr Vijay Kunadian, Professor Azfar Zaman

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Abstract

Background Coronary artery disease (CAD) is the most common cause for left ventricular dysfunction. Coronary artery bypass surgery (CABG) has not reduced mortality among patients with CAD and left ventricular systolic dysfunction receiving guideline-indicated pharmacological therapy. However, the benefit of percutaneous coronary intervention (PCI) among patients with left ventricular systolic dysfunction is not clear. Objectives A meta-analysis of studies utilizing PCI among patients with left ventricular systolic dysfunction (ejection fraction <= 40%) was performed to determine in-hospital and long-term (>= 1 year) mortality. Methods A systematic computerized literature search was performed using the search terms 'poor left ventricle', 'percutaneous coronary intervention', 'revascularization', 'LV dysfunction' and 'heart failure'. Studies of patients undergoing PCI for CAD in the presence of left ventricular systolic dysfunction were included. Studies that did not report long-term mortality data and same-centre studies were excluded. Results In total, 4766 patients from 19 studies were included in this meta-analysis. The mean (pooled estimate) age was 65 years [95% confidence interval (CI) 62-68] with 80% (95% CI 75-84%) males. The mean (pooled estimate) ejection fraction was 30% (95% CI 27-33%). The in-hospital mortality using random-effects model (13 studies, total PCI n = 2202) was 1.8%, n = 39 (95% CI 1.0-2.9%). The long-term mortality (mean pooled estimate 24 months) using the random-effects model (19 studies, total follow-up n = 2937) was 15.6%, n = 401 (95% CI 11.0-20.7%). Five studies compared PCI versus CABG (n = 455 vs. n = 502) and provide long-term mortality data (deaths-PCI: n = 102 vs. CABG: n = 115). The relative risk using the random-effects model (PCI vs. CABG) was 0.98 (95% CI 0.8-1.2, P = 0.83). Conclusion The present meta-analysis demonstrates that on the basis of available clinical studies, PCI among patients with left ventricular systolic dysfunction is feasible with acceptable in-hospital and long-term mortality and yields similar outcomes to CABG. However, neither intervention may improve outcome compared with pharmacological therapy alone. Coron Artery Dis 23:469-479 (c) 2012 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.


Publication metadata

Author(s): Kunadian V, Pugh A, Zaman AG, Qiu WL

Publication type: Article

Publication status: Published

Journal: Coronary Artery Disease

Year: 2012

Volume: 23

Issue: 7

Pages: 469-479

Print publication date: 01/11/2012

ISSN (print): 0954-6928

ISSN (electronic): 1473-5830

Publisher: Lippincott Williams & Wilkins

URL: http://dx.doi.org/10.1097/MCA.0b013e3283587804

DOI: 10.1097/MCA.0b013e3283587804


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