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Abstract
Percutaneous coronary intervention (PCI) is sometimes considered as an alternative therapeutic strategy to surgical revascularization in patients with coronary artery disease (CAD) and reduced left ventricular ejection fraction (LVEF). However, the types or conditions of patients that receive the clinical benefit of left ventricular reverse remodelling (LVRR) remain unknown. The purpose of this study was to investigate the determinants of LVRR following PCI in CAD patients with reduced LVEF. From 4394 consecutive patients who underwent PCI, a total of 286 patients with reduced LV systolic function (LVEF < 50% at initial left ventriculography) were included in the analysis. LVRR was defined as LV end-systolic volume reduction ≥ 15% and improvement of LVEF ≥ 10% at 6 months follow-up left ventriculography. Patients were divided into LVRR (n = 63) and non-LVRR (n = 223) groups. Multivariate logistic regression analysis revealed that unprotected left main coronary artery (LMCA) intervention was significantly associated with LVRR (P = 0.007, odds ratios [OR] 4.70, 95% confidence interval [CI] 1.54–14.38), while prior PCI (P = 0.001, OR 0.35, 95% CI 0.19–0.66), presence of in-stent restenosis (P = 0.016, OR 0.32, 95% CI 0.12–0.81), and presence of de-novo stenosis (P = 0.038, OR 0.36, 95% CI 0.14–0.95) were negatively associated with LVRR. These data suggest the potential prognostic benefit of unprotected LMCA intervention for LVRR and importance of angiographic follow-up in patients with CAD and LV systolic dysfunction.
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Details
1 The University of Tokyo, Department of Cardiovascular Medicine, Graduate School of Medicine, Tokyo, Japan (GRID:grid.26999.3d) (ISNI:0000 0001 2151 536X)
2 The University of Tokyo Hospital, Clinical Research Promotion Center, Tokyo, Japan (GRID:grid.412708.8) (ISNI:0000 0004 1764 7572)
3 Saitama Medical Center, Jichi Medical University, Division of Cardiovascular Medicine, Saitama, Japan (GRID:grid.415020.2) (ISNI:0000 0004 0467 0255)
4 The University of Tokyo, Department of Cardiovascular Medicine, Graduate School of Medicine, Tokyo, Japan (GRID:grid.26999.3d) (ISNI:0000 0001 2151 536X); The University of Tokyo, Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, Tokyo, Japan (GRID:grid.26999.3d) (ISNI:0000 0001 2151 536X)
5 The University of Tokyo, Department of Cardiovascular Medicine, Graduate School of Medicine, Tokyo, Japan (GRID:grid.26999.3d) (ISNI:0000 0001 2151 536X); Saitama Medical Center, Jichi Medical University, Division of Cardiovascular Medicine, Saitama, Japan (GRID:grid.415020.2) (ISNI:0000 0004 0467 0255)