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Percutaneous coronary intervention among patients with left ventricular systolic dysfunction: a review and meta-analysis of 19 clinical studies.
MedLine Citation:
PMID:  22960383     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Coronary artery disease (CAD) is the most common cause for left ventricular dysfunction. Coronary artery bypass surgery (CABG) has not reduced mortality among patients with CAD and left ventricular systolic dysfunction receiving guideline-indicated pharmacological therapy. However, the benefit of percutaneous coronary intervention (PCI) among patients with left ventricular systolic dysfunction is not clear. OBJECTIVES: A meta-analysis of studies utilizing PCI among patients with left ventricular systolic dysfunction (ejection fraction≤40%) was performed to determine in-hospital and long-term (≥1 year) mortality. METHODS: A systematic computerized literature search was performed using the search terms 'poor left ventricle', 'percutaneous coronary intervention', 'revascularization', 'LV dysfunction' and 'heart failure'. Studies of patients undergoing PCI for CAD in the presence of left ventricular systolic dysfunction were included. Studies that did not report long-term mortality data and same-centre studies were excluded. RESULTS: In total, 4766 patients from 19 studies were included in this meta-analysis. The mean (pooled estimate) age was 65 years [95% confidence interval (CI) 62-68] with 80% (95% CI 75-84%) males. The mean (pooled estimate) ejection fraction was 30% (95% CI 27-33%). The in-hospital mortality using random-effects model (13 studies, total PCI n=2202) was 1.8%, n=39 (95% CI 1.0-2.9%). The long-term mortality (mean pooled estimate 24 months) using the random-effects model (19 studies, total follow-up n=2937) was 15.6%, n=401 (95% CI 11.0-20.7%). Five studies compared PCI versus CABG (n=455 vs. n=502) and provide long-term mortality data (deaths-PCI: n=102 vs. CABG: n=115). The relative risk using the random-effects model (PCI vs. CABG) was 0.98 (95% CI 0.8-1.2, P=0.83). CONCLUSION: The present meta-analysis demonstrates that on the basis of available clinical studies, PCI among patients with left ventricular systolic dysfunction is feasible with acceptable in-hospital and long-term mortality and yields similar outcomes to CABG. However, neither intervention may improve outcome compared with pharmacological therapy alone.
Authors:
Vijayalakshmi Kunadian; Andrew Pugh; Azfar G Zaman; Weiliang Qiu
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-9-6
Journal Detail:
Title:  Coronary artery disease     Volume:  -     ISSN:  1473-5830     ISO Abbreviation:  Coron. Artery Dis.     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-9-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9011445     Medline TA:  Coron Artery Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
aInstitute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust bInstitute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University Medical School, Newcastle Upon Tyne, UK cChanning Laboratory, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA.
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