TY  - BOOK
AU  - Ben-Dor, Itsik
AU  - Gaglia, Michael AJ
AU  - Hauville, Camille
AU  - Kent, Kenneth M
AU  - Laynez-Carnicero, Ana
AU  - Lindsay, Joseph
AU  - Maluenda, Gabriel
AU  - Pichard, Augusto D
AU  - Sardi, Gabriel L
AU  - Satler, Lowell F
AU  - Suddath, William O
AU  - Torguson, Rebecca
AU  - Waksman, Ron
AU  - Xue, Zhenyi
TI  - Outcome of percutaneous coronary intervention utilizing drug-eluting stents in patients with reduced left ventricular ejection fraction
SN  - 0002-9149
PY  - 2012///
KW  - *Angioplasty, Balloon, Coronary/mt [Methods]
KW  - *Drug-Eluting Stents
KW  - *Myocardial Ischemia/su [Surgery]
KW  - *Stroke Volume
KW  - *Ventricular Dysfunction, Left/co [Complications]
KW  - Aged
KW  - Cause of Death/td [Trends]
KW  - Coronary Angiography
KW  - District of Columbia/ep [Epidemiology]
KW  - Echocardiography
KW  - Electrocardiography
KW  - Female
KW  - Follow-Up Studies
KW  - Gated Blood-Pool Imaging
KW  - Humans
KW  - Male
KW  - Middle Aged
KW  - Myocardial Ischemia/co [Complications]
KW  - Myocardial Ischemia/mo [Mortality]
KW  - Prognosis
KW  - Retrospective Studies
KW  - Risk Factors
KW  - Survival Rate/td [Trends]
KW  - Treatment Outcome
KW  - Ventricular Dysfunction, Left/mo [Mortality]
KW  - Ventricular Dysfunction, Left/pp [Physiopathology]
KW  - MedStar Health Research Institute
KW  - MedStar Heart & Vascular Institute
KW  - Comparative Study
KW  - Journal Article
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
N2  - Ischemic cardiomyopathy with depressed left ventricular ejection fraction (LVEF) is predictive of death after percutaneous coronary intervention (PCI), but its association with stent thrombosis (ST) and the need for repeat revascularization is less clearly defined. In total 5,377 patients undergoing PCI were retrospectively evaluated. Multivariable Cox proportional hazards regression and competitive outcome analysis were employed. The primary end point was 1-year major adverse cardiac events (all-cause death, Q-wave myocardial infarction, ST, and target lesion revascularization [TLR]). Individual end points of ST and of TLR were also evaluated. Patients with normal LVEF (>50%) were compared to those with mild (41% to 50%), moderate (25% to 40%), and severe (<25%) decreases in LVEF. Patients with abnormal LVEF were older and more commonly diabetic and had renal insufficiency and heart failure syndrome (p <0.001 for all variables). These patients demonstrated more angiographically complex lesions and less frequently received a drug-eluting stent. The primary end point was significantly increased in patients with lower LVEF (9.7% for normal LVEF vs 20.6% for severely decreased LVEF, p <0.001). ST occurred more frequently in these patients (1.4% for normal LVEF vs 6% for severely decreased LVEF, p <0.001), but clinically driven TLR did not significantly 130912 across LVEF categories. After adjustment, only moderate and severe LVEF decreases (i.e., LVEF <=40%) demonstrated an association with major adverse cardiac events and with the individual outcome of ST. Subgroup analysis of patients receiving only a drug-eluting stent or a bare-metal stent demonstrated no statistically significant differences for the probability of ST. In conclusion, decreased LVEF is not associated with clinically driven TLR but does increase the risk of ST. Patients with LVEF <=40% appear to be at significantly higher risk for ST and therefore might benefit from interventional and pharmacologic strategies aimed at minimizing this risk. Copyright  2012 Elsevier Inc. All rights reserved
UR  - http://dx.doi.org/10.1016/j.amjcard.2011.09.016
ER  -