PATIENTS with different coronary artery disease (CAD) presentations experience varying changes in left ventricular ejection fraction (LVEF) after percutaneous coronary intervention (PCI), with these changes influencing long-term mortality outcomes in certain cases.
This study aimed to evaluate differences in LVEF changes following PCI and their prognostic significance across three CAD presentations: chronic coronary disease (CCD), non-ST-segment elevation acute coronary syndromes (NSTE-ACS), and ST-segment elevation myocardial infarction (STEMI). A cohort of 8,181 patients underwent LVEF assessments both prior to and 6–8 months post-PCI. Changes in LVEF (ΔLVEF) were categorised as a decline (<0%), moderate improvement (>0% to <10%), or large improvement (≥10%). Five-year mortality served as the primary endpoint. Median ΔLVEF varied significantly among CAD groups: 0.0% for CCD, 1.0% for NSTE-ACS, and 3.0% for STEMI (P<0.001). Mortality outcomes were also stratified by ΔLVEF, showing no significant reduction in 5-year mortality for large LVEF improvements in CCD and NSTE-ACS. However, STEMI patients demonstrated a clear survival benefit with greater LVEF improvements (adjusted HR = 0.85 per 5% ΔLVEF increment).
These findings highlight that the clinical presentation of CAD influences both the degree of LVEF recovery post-PCI and its prognostic value. While significant LVEF improvements were strongly associated with reduced long-term mortality in STEMI patients, this relationship was not observed in NSTE-ACS cases and was modest in CCD. Clinically, this underscores the need for tailored approaches to post-PCI management, particularly for STEMI patients who may benefit most from therapies enhancing LVEF recovery. Further research should explore targeted interventions to improve LVEF outcomes in patients with CCD and NSTE-ACS, as well as the mechanistic pathways driving these differences.
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.
