CHANGES in left ventricular ejection fraction (LVEF) following percutaneous coronary intervention (PCI) differ based on coronary artery disease (CAD) presentations and have varied associations with long-term prognosis, new research has shown.
This study aimed to evaluate patterns of LVEF change (ΔLVEF) after PCI, and its relationship with 5-year mortality in patients with chronic coronary disease (CCD), non-ST-segment elevation acute coronary syndromes (NSTE-ACS), and ST-segment elevation myocardial infarction (STEMI). Data were analysed from 8181 patients who had paired LVEF measurements before and 6–8 months after PCI. Median ΔLVEF varied significantly across groups, with values of 0.0% (CCD), 1.0% (NSTE-ACS), and 3.0% (STEMI; P < 0.001). Among patients with a decline, moderate improvement, or large improvement in LVEF, 5-year mortality rates also varied by CAD presentation. Adjusted analyses showed that ΔLVEF was significantly associated with lower 5-year mortality in CCD (hazard ratio [HR] = 0.90 per 5% increment) and STEMI (HR = 0.85), but not in NSTE-ACS (HR = 0.97).
These findings highlight the importance of CAD presentation in predicting both the magnitude of LVEF recovery and its prognostic implications. While patients with STEMI experienced the greatest improvements in LVEF and a corresponding reduction in mortality, those with CCD demonstrated more modest improvements. NSTE-ACS patients, however, showed limited prognostic value from LVEF changes, underscoring potential differences in underlying disease mechanisms or therapeutic needs.
In clinical practice, this suggests that tailoring post-PCI follow-up strategies based on CAD presentation could optimise outcomes. For STEMI and CCD patients, closer monitoring of LVEF recovery may be crucial for identifying those at risk of poor prognosis. Further research is warranted to explore mechanisms driving these differences and to evaluate personalised approaches for improving long-term outcomes across CAD presentations.
Katrina Thornber, EMJ
Reference
Ndrepepa G et al. Left ventricular systolic function after percutaneous coronary intervention: patterns of change and prognosis according to clinical presentation of coronary artery disease. Clin Res Cardiol. 2024;DOI:10.1007/s00392-024-02588-y.
