https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Mannheim GmbH I. Medizinische Klinik Mannheim, Deutschland; 2Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland; 3MediClin Herzzentrum Lahr/Baden Innere Medizin und Kardiologie Lahr/Schwarzwald, Deutschland
Objective: The study investigates left ventricular ejection fraction (LVEF) as a prognostic factor among patients undergoing coronary angiography.
Background: Due to ongoing changes in demographics and advancements in treating individuals with cardiovascular conditions, the profile of patients who undergo cardiac catheterization (CA) has undergone a substantial transformation in recent decades. However, there remains a scarcity of data concerning the impact of LVEF on outcomes for unselected patients undergoing CA.
Methods: Consecutive patients undergoing invasive CA from 2016 to 2022 were included at one institution. Firstly, the prevalence and extent of CAD was assessed comparing patients with LVEF ≥55%, 54%-45%, 44%-35% and <35%. Secondly, the prognosis of patients undergoing CA was investigated stratified by LVEF with regard to the primary endpoint in-hospital all-cause mortality at 30 days. Secondary endpoints comprised the risk of acute myocardial infarction (AMI), revascularization and hospitalization for heart failure at 36 months of follow-up. Statistical analyses included Kaplan-Meier analyses, as well as uni- and multivariable Cox proportional regression analyses.
Results: From 2016 to 2022, 6,888 patients undergoing CA were included. Overall, patients with a LVEF between 45%-35% had the highest prevalence of CAD (79.7% vs.79.0%, 79.4% and 75.8; p = 0.001) and the highest prevalence of 3-vessel CAD compared to patients within other LVEF groups (39.3% vs. 20.7%, 33.5% and 38.6%; p = 0.001). However, patients with a LVEF between 54%-45% had the highest rates of percutaneous coronary intervention (PCI) (52.0% vs 36.6%, 48.0% and 42.6%, p = 0.001). At 30 days, patients with a LVEF of <35% had the highest risk of in-hospital all-cause mortality (16.6% vs. 0.9%, 2.5% and 4.8%; p = 0.001) compared to patients within other LVEF groups (i.e., 54%-45%: HR = 2.335; 95% CI 1.453 – 3.754; p = 0.001; 44%-35%: HR = 3.646; 95% CI 2.308 – 5.758; p = 0.001, <35%: HR = 11.531; CI 7.837 – 16.964; p = 0.001). Increased risk of all-cause mortality at 30 days was still observed after multivariable adjustment (i.e., 54%-45%: HR = 2.574; 95% CI 1.317 – 5,032; p = 0.006; 44%-35%: HR = 2.573; 95% CI 1.310 - 5.054; p = 0.006, <35%: HR = 5.326; CI 2.898 – 9.786; p = 0.001). Furthermore, the rates of AMI (21.4% vs 4.3%, 7.4% and 8.7%, p = 0.001) and heart failure (48.5% vs 12.0%, 21.7% and 37.4%, p = 0.001) at 36 months were highest among the patients with a LVEF of <35%.
Conclusion: LVEF of <35% represents an independent predictor of in-hospital all-cause mortality, AMI and heart failure in patient undergoing CA.