Influence of early left ventricular ejection fraction change on prognosis after initial PCI intervention in patients with acute coronary syndrome with impaired left ventricular ejection fraction

  AIM   To find out the relationship between early change of left ventricular ejection fraction (ΔLVEF) and long-term prognosis after initial percutaneous coronary intervention (PCI) intervention in patients with acute coronary syndrome (ACS) with impaired left ventricular ejection fraction (LVEF ≤50%) at admission.

  METHODS  Patients with ACS and impaired LVEF who were admitted to the Cardiology Department of Xijing Hospital for the first time and successfully underwent PCI from January 2010 to December 2015 were enrolled. LVEF value was collected before, 3 months, 6 months and 12 months after PCI. The early change of LVEF (ΔLVEF) was defined as the difference between 3-month LVEF and the baseline LVEF and the patients were stratified into three categories: nonrecovery group (ΔLVEF≤0), slightly increase group (0<ΔLVEF≤14) and significantly increase group (ΔLVEF>14). The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) and the relationship between early change of LVEF and MACCE was assessed in Cox multivariable models.

  RESULTS  There were significant differences in LVEF at baseline and 3 months among the three groups (all P<0.01). There was no statistical difference among the three groups in the all-cause mortality rate. The all-cause readmission rate in the nonrecovery group and the slightly increased group was higher than that in the significantly increased group. Compared with the non recovery group, the risk of MACCE in the slightly elevated group and the significantly elevated group decreased by 33% (HR=0.67, 95% CI: 0.51～0.88, P<0.01) and 57% (HR=0.43, 95% CI: 0.29～0.64, P<0.01), respectively. After multifactorial adjustment, age, cardiac function grade (3-4), hypertension, previous stroke history, low-density lipoprotein cholesterol, γ-Glutamyltransferase (GGT) and right coronal lesion are risk factors for predicting major adverse cardiovascular and cerebrovascular events, while early cardiac function changes (ΔLVEF) is a protective factor.

  CONCLUSION  The extent of early LVEF change has important prognostic value in ACS patients with impaired LVEF (≤50%) after primary PCI. Therefore, health education and early follow-up are important for these patients and so is the control of LDL and blood pressure and the monitoring of GGT.