P3621Coronary artery disease with impaired left ventricular function: any difference in outcome compare to preserved left ventricular function

Abstract

Introduction: Cardiovascular diseases are the major leading cause of death globally (estimated 17.7 million people, 31% of all global death in 2015) out of which 7.4 million were due to coronary artery diseases. On the other hand, the prevalence of heart failure in Asian population ranging from 1.26% to 6.7%. Aim: To identify the prevalence, immediate and long term outcomes of patients with impaired left ventricular function who underwent for per cutaneous coronary intervention for significant coronary artery disease over 2007-2013 in Malaysia according to National Cardiovascular Disease Database Per cutaneous Coronary Intervention (NCVD-PCI) registry data. Methods and results: Total 18582 patients had undergone per cutaneous coronary intervention for coronary artery disease from 2007- 2013. 8.4% (1570) patients were known to have impaired left ventricular ejection fraction -LVEF <40% (group I) while 82.1% (15259) were having LVEF >50% (group II). Mean age of 57.47 (±10.49) with majority of patients were male patients in both groups (86.1% in impaired EF and 82.2% in normal EF patients). Diabetes was more commonly associated in impaired left ventricular patients (49.5% vs 43.4%). Hypertension in 1100 (70.8%) group I patients and 10961 (73.2%) group II patients. Dyslipidemia noted in 65.4% of group I while 70.6% in normal EF group. High prevalence of cerebrovascular accident ( 2.5% vs 1.1%) together with significant increase rate of atrial fibrillation was noted in impaired left ventricular function patients (2.5% vs 1.1%). 48.9% (768) of impaired cardiac function patients presented with acute coronary syndrome out of which unstable angina, Non ST elevation myocardial infarction composite 15.2% (239) while the rest 33.7% (529) were ST elevation myocardial infarction. Femoral puncture approach were done more commonly in group I patients (54.3% vs 44.7%). Similar percentage of procedural complications such as pseudo aneurysm and bleeding episodes were identified in both patients group. Ostial lesions were more commonly identified in heart failure patients (7.6% vs 6.8%) and the same commonest goes to chronic total occlusion (7.5% vs 5.5%). Immediate outcome from in hospitalization such as death (0.9% vs 0.4%) and also cardiac deaths (0.6% vs 0.2%) were higher in patients with impaired LVEF. In survival analysis for long term clinical outcome, hazard ratio is found out to be 1.9 (95% CI 1.1-3.5; p value <0.05), indicating significant higher hazard of death in established coronary artery disease who are having impaired LVEF compare to preserved LVEF patients. Conclusion: In coronary artery disease patients who are diagnosed as having impaired LVEF as preexisting co morbid carries more complex coronary angiogram findings as well as poor immediate in hospital outcome compare to preserved LVEF patients. 2 years follow up also identified lower survival rate in those patients with impaired left ventricular function.