Left ventricular systolic function after percutaneous coronary intervention: patterns of change and prognosis according to clinical presentation of coronary artery disease

Background Whether there are differences in the left ventricular ejection fraction change (Delta LVEF) after percutaneous coronary intervention (PCI) and its association with long-term prognosis according to coronary artery disease (CAD) presentations is unknown. We assessed Delta LVEF after PCI and its association with 5-year mortality in various CAD presentations. Methods This study included 8181 patients with paired (before and 6-8 months after PCI) angiographic LVEF measurements: 4582 patients with chronic coronary disease (CCD), 1972 patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) and 1627 patients with ST-segment elevation myocardial infarction (STEMI). Delta LVEF (LVEF at 6-8 months minus baseline LVEF) was classified as follows: decline (Delta LVEF < 0), moderate improvement (Delta LVEF > 0 to < 10%) and large improvement (Delta LVEF >= 10%). The primary endpoint was 5 year mortality. Results In patients with CCD, NSTE-ACS and STEMI, Delta LVEF (median [25th-75th percentiles]) was 0.0% [- 3.0%; 4.0%], 1.0% [- 2.0%; 5.0%] and 3.0% [- 2.0%; 10.0%], respectively (P < 0.001). In patients with a decline, moderate improvement and large improvement of LVEF, 5-year mortality was 10.0%, 10.4% and 12.3% in patients with CCD, 10.8%, 10.7% and 18.1% in patients with NSTE-ACS and 10.6%, 8.2% and 5.2% in patients with STEMI. After adjustment, Delta LVEF was associated with 5-year mortality in patients with CCD (adjusted hazard ratio [HR] = 0.90, 95% confidence interval [0.83-0.97]) and STEMI (adjusted HR = 0.85 [0.75-0.95]) but not in patients with NSTE-ACS (adjusted HR = 0.97 [0.85-1.10]), with all 3 risk estimates calculated for 5% increment in the Delta LVEF. Conclusions The type of CAD presentation appears to impact both LVEF change after PCI and its association with 5-year mortality.