[Outcome of patients with coronary artery disease and left ventricular ejection fraction less than 50% undergoing percutaneous coronary intervention].

Objective: To investigate the in-hospital and long-term outcomes of patients with left ventricular ejection fraction (LVEF) <50% undergoing percutaneous coronary intervention (PCI) . Methods: From January to December 2013, 10 445 consecutive patients who underwent PCI in Fuwai Hospital and the LVEF value was available were prospectively included. The patients were divided into LVEF≥50% group (9 896 cases) and LVEF < 50% group (549 cases) . The in-hospital and 2-year clinical outcomes were compared between the 2 groups. The association between LVEF < 50% and clinical outcomes was assessed using multivariable Cox regression analysis. Results: (1) Compared with LVEF ≥50% group, LVEF < 50% group had higher rates of in-hospital all-cause death (1.1% (6/549) vs. 0.2% (17/9 896) , P< 0.01) , cardiac death (1.1% (6/549) vs. 0.1% (12/9 896) , P< 0.01) , in-stent thrombosis (0.7% (4/549) vs. 0.2% (18/9 896) , P< 0.01) , myocardial infarction (2.4% (13/549) vs. 1.2% (121/9 896) , P< 0.05) ,and major adverse cardiovascular and cerebrovascular events (MACCE) which including death, myocardial infarction, revascularization, in-stent thrombosis, and stroke (3.6% (20/549) vs. 1.4% (137/9 896) , P< 0.01) . (2) A total of 10 388 (99.5%) patients completed 2-year follow-up. Compared with LVEF ≥50% group, LVEF < 50% group had higher rates of 2-year all-cause death (4.7% (26/549) vs. 1.0% (101/9 896) , P< 0.01) , cardiac death (4.0% (22/549) vs. 0.5% (50/9 896) , P< 0.01) , in-stent thrombosis (3.1% (17/549) vs. 0.7% (71/9 896) , P< 0.001) , myocardial infarction (4.2% (23/549) vs. 1.9% (186/9 896) , P< 0.01) ,and MACCE (17.9% (98/549) vs. 11.8% (1 172/9 896) , P< 0.01) . There were no significant differences on the rates of 2-year target-vessel revascularization, bleeding and stroke between the two groups. (3) The multivariable Cox regression analysis demonstrated that LVEF < 50% was the independent risk factor of 2-year all-cause death ( HR =2.47, 95% CI 1.49-4.08, P< 0.01) , cardiac death ( HR =3.25, 95% CI 1.79-5.90, P< 0.01) , in-stent thrombosis ( HR =4.19, 95% CI 2.39-7.34, P< 0.01) , myocardial infarction ( HR =2.00, 95% CI 1.26-3.16, P< 0.01) , and MACCE ( HR =1.40, 95% CI 1.13-1.74, P <0.01) . (4) After propensity score matching, all in-hospital outcomes were similar between the two groups, including all-cause death, cardiac death, in-stent thrombosis, myocardial infarction, revascularization, bleeding, stroke, and MACCE (all P> 0.05) . After propensity score matching,the multivariable Cox regression analysis demonstrated that LVEF < 50% was still an independent risk factor of 2-year all-cause death ( HR =3.08, 95% CI 1.37-6.89, P< 0.01) , cardiac death ( HR = 4.12, 95% CI 1.53-11.07, P< 0.01) ,and in-stent thrombosis ( HR =3.82, 95% CI 1.27-11.5, P< 0.05) . Conclusion: LVEF < 50% is an independent risk factor of 2-year all-cause death, cardiac death, and in-stent thrombosis in patients undergoing PCI, but it does not increase the risk of target-vessel revascularization, bleeding or stroke.