The relationship between adverse outcomes and a full spectrum of ejection fraction in patients without acute myocardial infarction undergoing percutaneous coronary intervention

Abstract

Abstract Background There is insufficient study evaluating how the risk of adverse cardiovascular outcomes varies across the full range of LVEF in patients undergoing percutaneous coronary intervention (PCI). A more comprehensive evaluation could provide further understanding of prognosis and support the management of these patients. Purpose The present study aimed to assess the association between left ventricular ejection fraction (LVEF) and major adverse cardiovascular events (MACE) in patients with coronary artery diseases undergoing PCI. Methods A consecutive series of 9475 patients without acute myocardial infarction (AMI) undergoing PCI were enrolled into the study and followed up for a median 2.4 years. Patients were stratified into 8 groups by 5% intervals: under 40%, 40–45%, 45–50%, 50–55%, 55–60%, 60–65%, 65–70%, and over 70%. MACE, consisting of cardiac death, myocardial infarction, stent thrombosis, and revascularization, was evaluated as the outcome. Results MACE occurred in 594 (6.3%) patients. The MACE rates decreased before LVEF under 65% while increased after LVEF over 70%, showing a U-shaped pattern. The 65–70% group showed the lowest rate of MACE (4.5%). Consistently, in the Cox regression, the association between LVEF and MACE presented as a U-shaped pattern regardless of different age and sex groups, and after adjusted for clinical and procedural covariables. The LVEF categories lower than 65% or higher than 70% were independent predictors of MACE, compared with 65–70% group (Hazard ratios 1.311 to 2.657, all P value >0.05). Similar trend was also observed in restricted mean survival time analysis. Conclusions LVEF and MACE displayed a U-shaped association and patients with LVEF of 65–70% showed the lowest risk of MACE. The present study provided an insight into how the MACE risk changed in a wide spectrum of LVEF in patients without AMI undergoing PCI, which might improve preprocedural evaluation. Funding Acknowledgement Type of funding sources: None.