PREDICTION OF OUTCOMES OF PERCUTANEOUS REVASCULARIZATION VS OPTIMAL MEDICAL THERAPY FOR ISCHEMIC LEFT VENTRICULAR DYSFUNCTION

Abstract

Ischemic left ventricular dysfunction remains a major cause of morbidity and mortality worldwide. The optimal management strategy whether percutaneous coronary intervention or optimal medical therapy continues to be debated, especially in populations with limited access to advanced cardiac care. This study aimed to compare clinical, echocardiographic, and functional outcomes of PCI versus OMT in patients with ILVD in a tertiary care Hospital.

Methods:
A prospective comparative cohort study was conducted on 60 patients with angiographically confirmed ischemic LV dysfunction (LVEF ≤35%). Participants were assigned to PCI (n=30) or OMT (n=30) following multidisciplinary Heart Team evaluation and shared decision-making. Baseline demographics, comorbidities, echocardiographic findings, and biomarker profiles were recorded. All received guideline-directed medical therapy, while the PCI group underwent drug-eluting stent implantation. The primary endpoint was the 6-month composite of major adverse cardiovascular events (MACE: all-cause death, non-fatal myocardial infarction, or heart-failure hospitalization). Secondary outcomes included changes in LVEF, NYHA class, Kansas City Cardiomyopathy Questionnaire (KCCQ) score, and NT-proBNP levels.

Results:
The mean age of participants was 59.2 ± 9.8 years; 76.7% were male, and 61.7% had diabetes. At 6 months, MACE occurred in 13.3% of PCI versus 40.0% of OMT patients (RR = 0.33; 95% CI: 0.12–0.92; p = 0.02). Heart-failure hospitalizations were significantly lower with PCI (20.0% vs 50.0%; p = 0.01). PCI led to greater improvements in LVEF (+7.8% vs +2.1%; p < 0.001), NYHA functional class (70% vs 40% improved; p = 0.02), and KCCQ score (+15.2 ± 11.7 vs +6.0 ± 9.3; p = 0.004). Multivariable Cox regression confirmed PCI as an independent predictor of reduced MACE (HR = 0.41; 95% CI: 0.18–0.92; p = 0.03). The benefit was directionally greater among patients with documented myocardial viability. No significant differences were observed in major bleeding, stroke, or acute kidney injury.

Conclusion:
In patients with ischemic LV dysfunction, PCI was associated with significantly fewer cardiovascular events and superior functional recovery compared to OMT alone, without excess procedural risk. These findings highlight the potential benefit of revascularization in appropriately selected patients, especially when guided by viability assessment. Larger multicenter trials with long-term follow-up are warranted to validate these results within South Asian populations.