The impact of ejection fraction on outcomes after percutaneous coronary intervention in patients with congestive heart failure: An analysis of the National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry and Dynamic Registry

Holper, Elizabeth M.; Blair, John; Selzer, Faith; Detre, Katherine M.; Jacobs, Alice K.; Williams, David O.; Vlachos, Helen; Wilensky, Robert L.; Coady, Paul; Faxon, David P.; for the Percutaneous Transluminal Coronary Angioplasty Registry and Dynamic Registry Investigators,

doi:10.1016/j.ahj.2005.03.053

« Previous Next »American Heart Journal
Volume 151, Issue 1 , Pages 69-75, January 2006

The impact of ejection fraction on outcomes after percutaneous coronary intervention in patients with congestive heart failure: An analysis of the National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry and Dynamic Registry

Elizabeth M. Holper, MD, MPH, FACC
- University of Chicago, Chicago, IL
- Reprint requests: Elizabeth M. Holper, MD, MPH, University of Chicago, 5841 S Maryland Avenue, MC 6080 Room B601, Chicago, IL 60637.
John Blair, MD
- University of Chicago, Chicago, IL
Faith Selzer, PhD
- University of Pittsburgh, Pittsburgh, PA
Katherine M. Detre, MD, DrPH
- University of Pittsburgh, Pittsburgh, PA
Alice K. Jacobs, MD, FACC
- Boston University Medical Center, Boston, MA
David O. Williams, MD, FACC
- Rhode Island Hospital, Providence, RI
Helen Vlachos, MS
- University of Pittsburgh, Pittsburgh, PA
Robert L. Wilensky, MD, FACC
- University of Pennsylvania Medical Center, Philadelphia, PA
Paul Coady, MD, FACC
- Lankenau Hospital, Wynnewood, PA
David P. Faxon, MD, FACC
- University of Chicago, Chicago, IL
for the Percutaneous Transluminal Coronary Angioplasty Registry and Dynamic Registry Investigators

Received 2 August 2004; accepted 5 March 2005.

Background

Patients with congestive heart failure (CHF) have higher rates of adverse outcomes after percutaneous coronary intervention (PCI). A comprehensive analysis of outcomes in patients with CHF in the current era has not been done. We studied the outcomes of patients with CHF who underwent PCI in the National Heart, Lung, and Blood Institute–sponsored Percutaneous Transluminal Coronary Angioplasty (PTCA) and Dynamic registries.

Methods

We evaluated demographic and angiographic characteristics and the clinical outcomes of patients with CHF in the Dynamic Registry and the PTCA Registry, excluding patients with acute myocardial infarction. In the Dynamic Registry, patients with CHF (n = 503) were compared with patients without CHF (n = 4194), and patients with CHF with a preserved ejection fraction (EF) (n = 134) were compared with patients with CHF who have a reduced EF (n = 199). The patients with CHF in the 1997 through 2001 Dynamic Registry (n = 236) were then similarly compared with patients with CHF in the earlier PTCA Registry (n = 117).

Results

In the Dynamic Registry, compared with patients without CHF, patients with CHF had a higher-risk clinical and angiographic profile, and a higher mortality rate both inhospital (2.6% vs 0.4%, P ≤ .001) and at 1 year (13.1% vs 3.0%, P < .001). Patients with reduced EF had higher inhospital mortality rates and a trend toward higher mortality at 1 year. The patients with CHF in the Dynamic Registry compared with those in the PTCA Registry had a higher risk profile yet had significantly higher procedural success rates and improved clinical outcomes.

Conclusions

Although CHF remains a strong predictor of adverse outcomes after PCI, significant improvement seen in the past decade is likely related to improved procedural techniques and improved medical therapy.