Stent implantation in patients with severe left ventricular systolic dysfunction.

BACKGROUND: Patients with ischemic severe left ventricular (LV) dysfunction are at higher risk for death. We assessed the outcome following percutaneous coronary intervention (PCI) in patients with LV systolic dysfunction.
METHODS: From April 1993 to March 2004 337 consecutive patients with LV ejection fraction (LVEF)<or=35% underwent elective stent implantation at out Institutions.
RESULTS: The in-hospital course was uneventful in 322 (95.3%) patients. In-hospital death occurred in 5 patients (1.5%). At 2-year, 83 patients (24.6%) died (Non-surviving group), whereas 254 (75.4%) were alive (Surviving group). Sudden death occurred in 65% of cases. An acute myocardial infarction at follow-up occurred more often in the Non-surviving group (18% versus 5.4%; p=0.001). An implantable cardioverter-defibrillator (ICD) was implanted in 6.7% of patients in the Non-surviving group versus 20.7% of the Surviving group (p=0.005). LVEF significantly improved at follow-up only in the Surviving group (29+/-6 to 35+/-11; p<0.001), whereas remained unchanged in the Non-surviving group (27+/-5 to 26+/-7; p=0.30).The independent predictors of death at follow-up were: acute myocardial infarction (hazard ratio=4.94; 95% confidence interval=2.53-9.64; p<0.001), use of beta-blockers (HR=0.34; 95% CI=0.18-0.65; p=0.001), ICD implantation (0.16 [95% CI=0.05-0.51]; p=0.002), LVEF<25% (HR=2.16; 95% confidence interval 1.25-3.76; p=0.006), and completeness of revascularization (HR=0.29; 95% CI=0.10-0.82; p=0.020).
CONCLUSIONS: PCI in patients with LVEF<or=35% is feasible and safe. Independent predictors of death at 2-year are occurrence of an acute myocardial infarction, treatment by beta blockers, ICD implantation, LVEF<25% and completeness of revascularization.