Biondi Zoccai G, Moretti C, Abbate A, Lipinski MJ, De Luca G, Agostoni P, Meliga E, Goudreau E, Vetrovec GW, Trevi GP, Sheiban I. Percutaneous coronary stenting in patients with left ventricular systolic dysfunction: a systematic review and meta-analysis.
EUROINTERVENTION 2007;
3:409-415. [PMID:
19737725 DOI:
10.4244/eijv3i3a72]
[Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
AIMS
There is uncertainty on the clinical outcomes of percutaneous coronary intervention (PCI) in patients with left ventricular dysfunction (LVD). We thus performed a systematic review of studies reporting on PCI in LVD.
METHODS AND RESULTS
Pertinent studies were searched in PubMed, and included if reporting on >/=30 patients, with ejection fraction < 50%, and prevalently (>60%) treated with stents. The primary endpoint was the occurrence of major adverse cardiovascular events (MACE) at the longest follow-up. Outcomes were pooled with random-effect methods (95% confidence intervals). We retrieved 11 studies including 1,284 patients with ejection fraction <50% (specifically <40% in 1,033 and <30% in 211). All studies but one reported on bare-metal stenting only. In-hospital MACE occurred in 5% (3-6), with death in 2% (1-3), myocardial infarction in 3% (2-4), and repeat revascularisation in 1% (0-2). After a median of 18 months, MACE occurred in 33% (30-36), with death in 11% (9-13), myocardial infarction in 7% (6-9), and repeat revascularisation in 15% (13-18). Meta-regression suggested the beneficial impact of drug-eluting stents on MACE (p=0.030).
CONCLUSIONS
Currently available data support the adoption of percutaneous revascularisation in carefully selected patients with LVD. While event attrition remains substantial at long-term follow-up, drug-eluting stents hold the promise of significantly improving event-free and overall survival.
Collapse