Change in Left Ventricular Ejection Fraction With Coronary Artery Revascularization and Subsequent Risk for Adverse Cardiovascular Outcomes

• Published in: Circulation. Cardiovascular interventions Vol. 15; no. 4; p. e011284
• Main Authors: Velagaleti, Raghava S, Vetter, Joy, Parker, Rachel, Kurgansky, Katherine E, Sun, Yan V, Djousse, Luc, Gaziano, J Michael, Gagnon, David, Joseph, Jacob
• Format: Journal Article
• Language: English
• Published: United States 01.04.2022
• Subjects: Aged; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - therapy; Coronary Vessels; Female; Heart Failure - diagnosis; Heart Failure - etiology; Heart Failure - therapy; Humans; Male; Percutaneous Coronary Intervention; Stroke Volume; Treatment Outcome; Ventricular Function, Left; mortality; heart failure; percutaneous coronary intervention; hospitalization; coronary artery bypass
• ISSN: 1941-7640; 1941-7632
• DOI: 10.1161/CIRCINTERVENTIONS.121.011284

Coronary revascularization is recommended to treat ischemic cardiomyopathy. However, the relations of revascularization-associated ejection fraction (EF) change to subsequent outcomes have not been elucidated. In 10 071 veterans (mean age 67 years; 1% women; 15% non-White) who underwent a first percutaneous coronary intervention (PCI) or coronary artery bypass grafting between January 1, 1995, and December 31, 2010, and had prerevascularization and postrevascularization EF measured, we calculated delta-EF (postprocedure EF-preprocedure EF). We related delta-EF as a continuous measure and as categories (≤-5, -5<delta-EF<0, delta-EF=0, 0<delta-EF<5, and delta-EF≥5) to death (using Cox regression) and heart failure hospitalization days (using negative binomial regression) in multivariable-adjusted models, for total sample, and PCI and coronary artery bypass grafting strata. Over follow-up (mean/maximum 5/14 years) 56% died. Each 5% improvement in delta-EF was associated with statistically significant reductions in death and heart failure hospitalization days of 5% (95% CI, 3%-7%) and 10% (95% CI, 5%-15%), respectively, in the total sample and 6% (95% CI, 4%-8%) and 10% (95% CI, 5%-16%), respectively, in the PCI subgroup. Patients in the highest delta-EF category had 27% (95% CI, 19%-34%) lower mortality (30% [95% CI, 21%-37%] lower in PCI stratum) and ≈40% lower heart failure hospitalization days in total sample and PCI stratum, compared with those in the lowest category. Relations of delta-EF and outcomes in coronary artery bypass grafting subgroup did not reach statistical significance. Revascularization-associated EF improvement was associated with significant reductions in mortality and heart failure hospitalization burden, particularly in the PCI subgroup.