Impact of left ventricular dysfunction on the outcome of patients undergoing complex high-risk indicated percutaneous coronary intervention

D. Obradovic (Dresden)¹, J. Sacha (Opole)², F. Woitek (Dresden)¹, Y. Merhej (Dresden)³, J. Drell (Dresden)³, C. M. Schubert (Dresden)³, A. Laupp (Dresden)¹, A. Conrad (Dresden)¹, S. Haußig (Dresden)¹, J. Mierke (Dresden)¹, J. Vogel (Dresden)⁴, E. B. Winzer (Dresden)¹, S. Jellinghaus (Dresden)¹, A. Linke (Dresden)⁵, N. Mangner (Dresden)^1
1Herzzentrum Dresden GmbH an der TU Dresden Klinik für Innere Medizin, Kardiologie und Intensivmedizin Dresden, Deutschland; ²University Hospital in Opole Department of Cardiology Opole, Polen; ³Heart Centre Dresden, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology Department for Internal Medicine and Cardiology Dresden, Deutschland; ⁴Herzzentrum Dresden GmbH an der TU Dresden Dresden, Deutschland; ⁵Herzzentrum Dresden GmbH an der TU Dresden Klinik für Innere Medizin und Kardiologie Dresden, Deutschland

Background: We investigated the impact of LV-EF in patients undergoing complex high-risk indicated percutaneous coronary intervention (HRPCI) to predict survival and evaluated the impact of complete revascularization (CR) in patients with low (l-EF) compared to preserved LV-EF (p-EF).

Methods: Prospective multi-centre registry from 1 German and 22 Polish centres including 1387 patients undergoing HRPCI. Patients were divided according to baseline LV-EF (l-EF ≤40% vs. p-EF >40%). The primary outcomes were 30-day and 1-year mortality and safety was assessed according to (V)ARC definitions.

Results: L-EF patients were younger, more often male, had more severe heart failure symptoms and a higher logEuroScore II (5.9% (IQR 3.3; 10.6) vs 2.9% (IQR 1.7; 5.2), p<0.01). There were higher rates of triple-vessel disease and left main stenosis, as well as a higher baseline Syntax Score (35 (IQR 24; 45) vs. 29 (IQR 22, 40), p<0.001) in l-EF compared to p-EF. The use of mechanical circulatory support was more frequent in l-EF compared to p-EF (56.2% vs 17.8, p<0.001). CR (residual Syntax-Score ≤8) was achieved in 53.9% and 59.5% in l-EF and p-EF, respectively (p=0.07).

There were higher rates of BARC 3-5 bleeding, access site complications, and acute kidney injury in l-EF compared to p-EF, whereas myocardial infarction and stent thrombosis were comparable.

The 30-day (10.2% vs. 2.1%, p<0.001) and 1-year mortality (19.9% vs. 9.2%, p<0.001) was higher in l-EF compared to p-EF. Adjusting for age, sex, logEuroScore II and baseline Syntax-Score, LV-EF was independently associated with 1-year mortality (p-EF vs. l-EF HR 0.46 (95%-CI 0.32; 0.65).

CR had no impact on 1-year mortality in p-EF (CR vs. no CR: 9.0% vs 8.4%, p=0.85), whereas it appeared to be associated with a lower 1-year mortality in l-EF (CR vs. no CR 17.3% vs 25.4%, p=0.04) (p interaction=0.003).

Conclusion: L-EF was associated with higher 30-day and 1-year mortality rates in patients undergoing HRPCI. Complete revascularisation reduced the one-year mortality rate in patients with l-EF, but had no impact on patients with p-EF.