Effect of left ventricular systolic dysfunction on secondary medical prevention and clinical outcome in stable coronary artery disease patients.

BACKGROUND

Limited recent data are available in the literature on whether the presence of left ventricular systolic dysfunction (LVSD) affects the therapeutic management of patients with stable coronary artery disease (CAD).

AIMS

The objectives of this study were to analyse prevalence, effect on therapeutics and prognosis of LVSD in stable CAD.

METHODS

We prospectively included 4184 CAD outpatients free from any myocardial infarction or coronary revascularization for>1year. Left ventricular ejection fraction (EF) was available for 4124 (98.6%) patients. Follow-up was performed at 2years. All events were adjudicated blindly.

RESULTS

The mean EF was 57.5±10.8%, and 201 (4.9%) patients had an EF≤35%. The prescription of renin-angiotensin system inhibitors and beta-blockers was inversely related to EF, and reached>90% in patients with EF≤35%. Seventy-five (37.3%) of the patients with EF≤35% received a mineralocorticoid receptor antagonist. Eighty-five (42.3%) of the patients with EF≤35% had an implantable cardioverter defibrillator. Clinical follow-up data were obtained for 4090 patients (99.2%). Event rates were higher in patients with low EF (adjusted hazard ratio [95% confidence interval] for EF≤35%, with EF≥60% as reference: 3.93 [2.60-5.93] and 7.12 [3.85-13.18], for all-cause death and cardiovascular death, respectively).

CONCLUSIONS

In patients with stable CAD, LVSD is well taken into account by cardiologists, with extensive use of evidence-based medications and interventions. Despite this, LVSD remains a major prognostic indicator in this population.