Impact of left ventricular systolic function on the outcomes of percutaneous coronary intervention for unprotected left main disease

Abstract

To evaluate the impact of left ventricular systolic function on the outcomes of percutaneous coronary intervention (PCI) for unprotected left main (ULM) disease. The relevant baseline and outcome data of patients undergoing PCI for ULM disease at our hospital were collected from September 2006 to August 2009. The enrolled patients were divided into two groups according to left ventricular ejection fraction (LVEF): LVEF ≥ 40% group (n = 130) and LVEF < 40% group (n = 56). The baseline and outcome data were compared between two groups. Multivariable regression analysis was performed to appraise the prognostic role of LVEF < 40% in patients undergoing PCI for ULM disease. There were more patients with diabetes mellitus, a previous history of myocardial infarction, previous PCI/CABG (coronary artery bypass grafting) and NSTEMI (non-ST-segment elevation myocardial infarction) in LVEF < 40% group than LVEF ≥ 40% group (P < 0.05). The major adverse cardiovascular and cerebral vascular event (MACCE) rate was higher in LVEF < 40% group than LVEF ≥ 40% group (33.9% vs 18.5%, P = 0.022). And the rates of cardiac death, all-cause death and MI were also higher in LVEF < 40% group than LVEF ≥ 40% group (7.1% vs 1.5%, P = 0.047; 10.7% vs 3.1%, P = 0.034; 14.3% vs 4.6%, P = 0.022). Female gender, diabetes mellitus, previous PCI/CABG, NSTEMI/STEMI, LVEF < 40%, multiple-vessel disease, LM distal or bifurcation lesion and multiple-stent implantation were independent predictors of MACCE in patients undergoing PCI for ULM disease. Impaired left ventricular systolic function (LVEF < 40%)affects the prognosis of ULM patients undergoing PCI. Reduced LVEF (LVEF < 40%) is the strongest predictor of adverse events in these patients.