Predictors of left ventricular ejection fraction in high-risk percutaneous coronary interventions

Authors

Vasileios F. Panoulas
Javier Escaned
Jonathan M. Hill
Erin Barker
Karin Butler
Ali Almedhychy
Stelios I. Tsintzos
William W. O'Neill, Henry Ford HealthFollow

Recommended Citation

Panoulas VF, Escaned J, Hill JM, Barker E, Butler K, Almedhychy A, Tsintzos SI, and O'Neill WW. Predictors of left ventricular ejection fraction in high-risk percutaneous coronary interventions. Front Cardiovasc Med 2024; 11:1342409.

Document Type

Article

Publication Date

1-1-2024

Publication Title

Front Cardiovasc Med

Abstract

Revascularization completeness after percutaneous coronary intervention (PCI) is associated with improved long-term outcomes. Mechanical circulatory support [intra-aortic balloon pump (IABP) or Impella] is used during high-risk PCI (HR-PCI) to enhance peri-procedural safety and achieve more complete revascularization. The relationship between revascularization completeness [post-PCI residual SYNTAX Score (rSS)] and left ventricular ejection fraction (LVEF) in HR-PCI has not been established. We investigated LVEF predictors at 90 days post-PCI with Impella or IABP support. Individual patient data (IPD) were analyzed from PROTECT II (NCT00562016) in the base case. IPD from PROTECT II and RESTORE-EF (NCT04648306) were naïvely pooled in the sensitivity analysis. Using complete cases only, linear regression was used to explore the predictors of LVEF at 90 days post-PCI. Models were refined using stepwise selection based on Akaike Information Criterion and included: treatment group (Impella, IABP), baseline characteristics [age, gender, race, New York Heart Association Functional Classification, LVEF, SYNTAX Score (SS)], and rSS. Impella treatment and higher baseline LVEF were significant predictors of LVEF improvement at 90 days post-PCI (p ≤ 0.05), and a lower rSS contributed to the model (p = 0.082). In the sensitivity analysis, Impella treatment, higher baseline LVEF, and lower rSS were significant predictors of LVEF improvement at 90 days (p ≤ 0.05), and SS pre-PCI contributed to the model (p = 0.070). Higher baseline LVEF, higher SS pre-PCI, lower rSS (i.e. completeness of revascularization), and Impella treatment were predictors of post-PCI LVEF improvement. The findings suggest potential mechanisms of Impella include improving the extent and quality of revascularization, and intraprocedural ventricular unloading.

PubMed ID

38370154

Volume

11

First Page

1342409

Last Page

1342409