Abstract 11123: Outcomes After Percutaneous Coronary Intervention for Patients With Stable Coronary Disease and Left Ventricular Systolic Dysfunction

Abstract

Background: Clinical trial data suggest a modest improvement in outcomes when coronary bypass surgery (CABG) is added to medical therapy for patients with stable coronary artery disease (CAD) and left ventricular systolic dysfunction (LVSD). However, limited data are available to understand the impact of percutaneous coronary interventions (PCI) on mortality for patients with stable CAD and LVSD. Methods: We studied 901 patients in the Duke Databank for Cardiovascular Diseases. All patients underwent a coronary angiogram at Duke University for suspected CAD between 1995 and 2012. Patients included in the analysis all had CAD amenable to PCI (>50% stenosis) in at least 1 vessel, reduced LVEF (< 35%), and stable CAD. Patients with CCS class III or IV angina or CABG within 30 days were excluded. Of 901 patients, 259 were treated with PCI and 642 were treated with medical therapy. Propensity scores for PCI, created from 24 different variables (including age, LVEF, comorbid conditions, and medications), were used to assemble a matched cohort of 444 patients (222 pairs) receiving PCI or medical therapy alone. A survival curve was derived using the Kaplan-Meier method and the hazard ratio (HR) for mortality was estimated using Cox regression modeling. Results: In the matched cohort, the mean age was 63 years with 321 (72%) males. Three-vessel disease was present in 70 patients (16%). The mean EF was 27% and 153 (35%) reported NYHA Class III/IV symptoms; 392 (88%) were treated with beta-blockers and 378 (85%) with ACE-inhibitors or ARBs. Over 12 years of follow-up, patients in both groups had similar mortality (Figure), HR 0.87 (95% confidence interval 0.68-1.10). Conclusion: In this well-profiled, propensity-matched cohort, there was no significant difference in long-term mortality between patients treated with medical therapy alone or with medical therapy plus PCI. More studies are needed to understand the impact of PCI on other outcomes including symptoms and functional status.