A Systematic Review And Meta-analysis Of The Outcomes Of Percutaneous Coronary Intervention For Patients With Severe Left Ventricular Systolic Dysfunction

Background: Coronary artery disease(CAD) is the most common cause of left ventricular dysfunction. Conflicting evidence exists with regards to available treatments and patient prognosis. Revascularization may improve ventricular function while coronary artery bypass surgery(CABG) has significantly improved survival. There are several single studies which proved the effectiveness and safety of PCI,but not much systematic large studies. Objective: To ascertain the in-hospital and long-term(≥1 year)outcomes of CAD patients with left ventricular systolic dysfunction(ejection fraction≤40%) after PCI according to a meta-analysis. Methods: A systematic literature search was performed using the search terms ‘poor left ventricle’, ‘left ventricular dysfunction’,‘heart failure’, ‘percutaneous coronary intervention’, and ‘revascularization’ and a series of random- effect meta-analyses were conducted to evaluate the short- and long-term outcomes of PCI of the selected studies. Single-center studies and those that did not report evidence on long-term mortality were excluded in the analysis. All statistical tests were performed with 95% confidence intervals. A P-value of less than 0.05 was considered statistically significant. Results: A total of 25 studies involving 5,471 patients(78% males, average age 65.1 years) were identified. The average follow-up duration was approximately 27 months. The majority of patients had multi-vessel disease(68%),hypertension(66%), hypercholesterolemia(59%), and prior myocardial infarction(MI)(58%). The meta-analysis showed that the in-hospital occurrence of major adversecardiac events(MACE), deaths, MI, and repeat revascularization(RR) after PCI were controlled at 4%, 2%, 2%, and 1%, respectively. The pooled estimates for long-term outcome were 40% MACE, 20% deaths, 4% MI, and 21% RR. There was no significant difference in mortality risk when PCI was compared with CABG(P=0.71).Conclusion:Under the given medical conditions,PCI carries acceptable short- and long-term outcomes for CAD patients with left ventricular systolic dysfunction,when compared with CABG,PCI carries similar long-term mortality.