Percutaneous coronary intervention outcomes in patients with stable coronary disease and left ventricular systolic dysfunction.
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2019-12
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AIMS:We sought to better understand the role of percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD) and moderate or severe left ventricular systolic dysfunction. METHODS AND RESULTS:Using data from the Duke Databank for Cardiovascular Disease, we analysed patients who underwent coronary angiography at Duke University Medical Center (1995-2012) that had stable CAD amenable to PCI and left ventricular ejection fraction ≤35%. Patients with acute coronary syndrome or Canadian Cardiovascular Society class III or IV angina were excluded. We used propensity-matched Cox proportional hazards to evaluate the association of PCI with mortality and hospitalizations. Of 901 patients, 259 were treated with PCI and 642 with medical therapy. PCI propensity scores created from 24 variables were used to assemble a matched cohort of 444 patients (222 pairs) receiving PCI or medical therapy alone. Over a median follow-up of 7 years, 128 (58%) PCI and 125 (56%) medical therapy alone patients died [hazard ratio 0.87 (95% confidence interval 0.68, 1.10)]; there was also no difference in the rate of a composite endpoint of all-cause mortality or cardiovascular hospitalization [hazard ratio 1.18 (95% confidence interval 0.96, 1.44)] between the two groups. CONCLUSIONS:In this well-profiled, propensity-matched cohort of patients with stable CAD amenable to PCI and moderate or severe left ventricular systolic dysfunction, the addition of PCI to medical therapy did not improve long-term mortality, or the composite of mortality or cardiovascular hospitalization. The impact of PCI on other outcomes in these high-risk patients requires further study.
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DeVore, Adam D, Eric Yow, Mitchell W Krucoff, Matthew W Sherwood, Linda K Shaw, Karen Chiswell, Christopher M O'Connor, Erik Magnus Ohman, et al. (2019). Percutaneous coronary intervention outcomes in patients with stable coronary disease and left ventricular systolic dysfunction. ESC heart failure, 6(6). pp. 1233–1242. 10.1002/ehf2.12510 Retrieved from https://hdl.handle.net/10161/20594.
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Scholars@Duke
Mitchell Wolfe Krucoff
Matthew William Sherwood
I am striving to become a clinical and research leader in structural heart disease and complex coronary disease, specifically in the use of antithrombotic agents after structural heart interventions. I will also explore the significance of bleeding/vascular complications and stroke in these patients as well as potential therapies such as transfusion, and embolic protection devices.
Karen Chiswell
Ph.D., North Carolina State University - 2007
I work closely with clinical and quantitative colleagues to provide statistical leadership, guidance and mentoring on the design, execution, and analysis of clinical research studies. My work includes design and analysis of observational studies (including large cardiovascular registries, and clinical care databases linked with electronic health record data) and early-phase trials in pediatric populations. My statistical interests include study design, linear and non-linear mixed effects models, survival analysis, biology- and mechanism-based models, and statistical thinking and learning.
Erik Magnus Ohman
Dr. Ohman, Professor of Medicine, received medical degrees from the Royal College of Surgeons in Ireland and the National University of Ireland (1984, Fellowship 1984-1987), and completed his training in cardiology at Duke University (1987-1991), where he has remained on faculty. In 2001, he became Chief of Cardiology at the University of North Carolina at Chapel Hill, where he founded the UNC Heart Center and became its first director. In 2005 he returned to Duke to pursue his interest in advanced coronary disease as the Director of the Program for Advanced Coronary Disease. Since that time, he has been appointed to Associate Director of the Duke Heart Center, the Kent and Siri Rawson Director for the Program for Advanced Coronary Disease, and most recently, Vice-Chair of Development and Innovation in the Department of Medicine.
Dr. Ohman’s clinical and research interests include interventional cardiology and high-risk supported PCI, and treatment of patients with advanced/complex coronary disease. He has researched how to improve patient care through the use of guidelines-based therapies and adherence, and examining global cardiovascular risk and health. He has been a participant on numerous guidelines writing committees, served on the ACC/AHA oversight committee for guidelines development, and has served on the steering committees for trials on ST-elevation myocardial infarction and non-ST-elevation ACS. He is a consultant to the National Institutes of Health, and a consultant for the FDA Advisory Panel for Cardiovascular Devices.
Dr. Ohman has published over 600 peer-reviewed papers and three books in cardiovascular medicine. He holds three U.S. patents in reperfusion therapy. He is an associate editor for the American Heart Journal and serves on the editorial boards of the Journal of the American College of Cardiology and the American Journal of Cardiology. He is a Fellow of the Royal College of Physicians in Ireland, the Royal Society of Medicine (U.K.), the European Society of Cardiology, the Society of Cardiac Angiography and Interventions, and the American College of Cardiology.
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