Clinical InvestigationPercutaneous coronary intervention in patients with stable coronary artery disease and left ventricular systolic dysfunction: insights from the VA CART program
Section snippets
Data sources
This study utilized data from the VA Clinical Assessment, Reporting, and Tracking (CART) Program. Part of CART's quality and safety program involves a clinical software application to collect standardized data on all invasive cardiac procedures in the VA. The CART software was designed using standardized data definitions from the National Cardiovascular Data Registry and the dataset has been previously validated.11,12 Furthermore, its integration with the VA Computerized Patient Record System
Results
From January 1, 2008 through December 31, 2015, there were 16,751 coronary angiograms recorded in the CART system documenting at least 1 significant stenosis and a corresponding LVEF ≤35%. After excluding those with ACS, prior PCI, prior CABG, subsequent CABG within 30 days of index coronary angiography, or significant comorbidities, there were 4,664 patients identified for study eligibility. A final study sample of 4,628 was defined after exclusion of medical center sites that had patients
Discussion
Recent clinical trial data have shown survival benefit among patients with significant coronary stenosis and LVEF ≤35% who underwent revascularization by CABG.4 However, the role of PCI in this context remains uncertain as no clinical trial to date has successfully evaluated its efficacy and safety specifically on patients with severe left ventricular systolic dysfunction. In this retrospective study of patients with stable ischemic heart disease and documented LVEF ≤35%, revascularization by
Conclusions
In conclusion, in patients with stable ischemic heart disease and documented LVEF ≤35%, revascularization by PCI was associated with a significant improvement in survival compared with optimal medical therapy. Future prospective studies and randomized clinical trials are necessary to define the potential role of PCI in ischemic cardiomyopathy with severe left ventricular systolic dysfunction.
Funding sources
No extramural funding was used to support this work.
Disclosures
Dr. Adam D. DeVore receives research support from the American Heart Association, Amgen, AstraZeneca, Bayer, IntraCellular Therapies, Luitpold Pharmaceuticals, Merck, the NHLBI, Novartis, and PCORI. He also provides consulting services for Amgen, AstraZeneca, Bayer, InnaMed, LivaNova, Mardil Medical, Novartis, Procyrion, scPharmaceuticals, and Zoll.
Dr. J. Antonio Gutierrez provides consulting services for Amgen and Janssen Pharmaceuticals.
Dr. Rajesh V. Swaminathan receives research support from
Acknowledgments
The authors acknowledge the contributions of Anna Baron, PhD (Colorado School of Public Health, Colorado University Anschutz Medical Campus) and Gray Grunwald, PhD, MA (Colorado School of Public Health, Colorado University Anschutz Medical Campus) in statistical analysis development and manuscript revision.
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