PCI tied to death, MI, stroke in patients with LMCA, LV dysfunction

Percutaneous coronary intervention (PCI), compared with coronary artery bypass grafting (CABG), in the revascularization of left main coronary artery (LMCA) disease may lead to death, myocardial infarction (MI), or stroke in patients with moderate or severe left ventricular (LV) dysfunction, reveals a study.

“However, the risk for the [composite] outcome was comparable between PCI and CABG in those with normal or mild left ventricular dysfunction,” the investigators said.

Overall, 3,488 patients with LMCA disease who underwent CABG (n=1,355) or PCI (n=2,133) from the IRIS-MAIN registry were included in the analysis. LV function was categorized according to LV ejection fraction (LVEF) as normal function (LVEF ≥55 percent), mild dysfunction (LVEF ≥45 percent to <55 percent), moderate dysfunction (LVEF ≥35 percent to <45 percent), or severe dysfunction (LVEF <35 percent). The primary outcome was a composite of death, MI, or stroke.

Of the patients, 2,641 (75.5 percent) had normal LVEF and 403 (11.6 percent), 260 (7.5 percent), and 184 (5.3 percent) had mild, moderate, and severe LV dysfunction at baseline, respectively.

PCI, compared with CABG, correlated with a higher adjusted risk of the primary outcome in patients with moderate (hazard ratio [HR], 2.23, 95 percent CI, 1.17–4.28) or severe (HR, 2.45, 95 percent CI, 1.27–4.73) dysfunction. On the other hand, PCI and CABG showed similar risks of the composite outcomes in those with normal (HR, 0.80, 95 percent CI, 0.59–1.07) or mild (HR, 1.17, 95 percent CI, 0.63–2.17) dysfunction (p_interaction=0.004).

“LMCA disease is associated with high mortality and morbidity due to a large area of jeopardized myocardium,” the investigators said.