Steffen Henning Johann, Schupp Tobias, Abumayyaleh Mohammad, Kuhn Lasse, Steinke Philipp, Dudda Jonas, Weidner Kathrin, Rusnak Jonas, Jannesari Mahboubeh, Siegel Fabian, Duerschmied Daniel, Behnes Michael, Akin Ibrahim
Cardiology, Haemostasis, and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, 68167 Mannheim, Germany.
European Center for AngioScience (ECAS), German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, and Centre for Cardiovascular Acute Medicine Mannheim (ZKAM), Medical Centre Mannheim and Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany.
J Clin Med. 2025 Jul 23;14(15):5219. doi: 10.3390/jcm14155219.
To evaluate the long-term prognostic value of left ventricular ejection fraction (LVEF) in consecutive patients undergoing invasive coronary angiography (CA). LVEF is a key prognostic marker in cardiovascular disease, but its value across different clinical indications for CA remains insufficiently characterized. Consecutive patients undergoing CA between January 2016 and August 2022 were retrospectively included at one institution. Patients were stratified into four LVEF groups: ≥ 55%, 45-54%, 35-44%, and <35%. The primary endpoint was rehospitalization for heart failure (HF) at 36 months. Secondary endpoints were acute myocardial infarction (AMI) and coronary revascularization. Kaplan-Meier and multivariable Cox regression analyses were conducted within the entire study cohort and pre-defined subgroups. A total of 6888 patients were included (median age: 71 years; 65.2% males). LVEF < 35% was associated with a higher comorbidity burden and more extensive coronary artery disease (e.g., three-vessel CAD: 38.6% vs. 20.7%, < 0.001). Event rates for HF rehospitalization and AMI increased progressively with declining LVEF, while revascularization rates varied across categories. Statistically significant differences across LVEF groups were observed for all three endpoints in unadjusted analyses (log-rank < 0.001). In multivariable models, LVEF < 35% independently predicted HF rehospitalization (HR = 3.731, < 0.001) and AMI (HR = 4.184, < 0.001), but not revascularization (HR = 0.867, = 0.378). The prognostic association was demonstrated across all subgroups stratified by age, sex, subtype of acute coronary syndrome, and CAD severity. Reduced LVEF is an independent predictor of HF rehospitalization and AMI in patients undergoing coronary angiography, irrespective of its indication, whereas no independent association was observed with coronary revascularization.
评估连续接受有创冠状动脉造影（CA）患者的左心室射血分数（LVEF）的长期预后价值。LVEF是心血管疾病的关键预后标志物，但其在不同CA临床指征中的价值仍未得到充分描述。在一家机构对2016年1月至2022年8月期间连续接受CA的患者进行回顾性纳入。患者被分为四个LVEF组：≥55%、45 - 54%、35 - 44%和<35%。主要终点是36个月时因心力衰竭（HF）再次住院。次要终点是急性心肌梗死（AMI）和冠状动脉血运重建。在整个研究队列和预先定义的亚组中进行了Kaplan-Meier和多变量Cox回归分析。共纳入6888例患者（中位年龄：71岁；65.2%为男性）。LVEF<35%与更高的合并症负担和更广泛的冠状动脉疾病相关（例如，三支血管CAD：38.6%对20.7%，<0.001）。HF再次住院和AMI的事件发生率随着LVEF的下降而逐渐增加，而血运重建率在各分类中有所不同。在未调整分析中，所有三个终点在LVEF组之间均观察到统计学显著差异（对数秩<0.001）。在多变量模型中，LVEF<35%独立预测HF再次住院（HR = 3.731，<0.001）和AMI（HR = 4.184，<0.001），但不能预测血运重建（HR = 0.867，= 0.378）。在按年龄、性别、急性冠状动脉综合征亚型和CAD严重程度分层的所有亚组中均显示出预后关联。LVEF降低是接受冠状动脉造影患者HF再次住院和AMI的独立预测因素，无论其指征如何，但未观察到与冠状动脉血运重建有独立关联。
