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

Abstract

Background: Ischemic left ventricular dysfunction (ILVD) remains a leading cause of morbidity and mortality worldwide. The optimal management strategy—percutaneous coronary intervention (PCI) versus optimal medical therapy (OMT), is still debated, particularly in populations with limited access to advanced cardiac interventions. Objective: To compare the clinical, echocardiographic, and functional outcomes of PCI versus OMT in patients with ILVD in a tertiary care setting in Pakistan. Study Design: Prospective comparative cohort study. Setting: Department of Cardiology, Ch Pervaiz Elahi Institute of Cardiology, Multan, Pakistan. Duration of Study: January 2024 to January 2025. Methods: Sixty patients with angiographically confirmed ILVD (LVEF ≤35%) were enrolled and divided into two equal groups: PCI (n=30) and OMT (n=30), following multidisciplinary Heart Team evaluation and shared decision-making. All received guideline-directed medical therapy; PCI patients additionally underwent drug-eluting stent implantation. The primary endpoint was the 6-month incidence of major adverse cardiovascular events (MACE: all-cause death, non-fatal myocardial infarction, or heart-failure hospitalization). Secondary outcomes included changes in left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) class, Kansas City Cardiomyopathy Questionnaire (KCCQ) score, and NT-proBNP levels. Statistical analyses included relative risk (RR) estimation and Cox regression modeling, with p < 0.05 considered significant. Results: The mean participant age was 59.2 ± 9.8 years; 76.7% were male, and 61.7% had diabetes. At 6 months, MACE occurred in 13.3% of the PCI group versus 40.0% in the OMT group (RR = 0.33; 95% CI: 0.12–0.92; p = 0.02). Heart-failure hospitalizations were also lower in the PCI group (20.0% vs 50.0%; p = 0.01). PCI led to greater improvements in LVEF (+7.8% vs +2.1%; p < 0.001), NYHA class (70% vs 40% improved; p = 0.02), and KCCQ score (+15.2 ± 11.7 vs +6.0 ± 9.3; p = 0.004). Multivariable analysis identified PCI as an independent predictor of reduced MACE (HR = 0.41; 95% CI: 0.18–0.92; p = 0.03). The benefit was more pronounced among patients with myocardial viability. No significant differences were found in major bleeding, stroke, or acute kidney injury between groups. Conclusion: In patients with ischemic left ventricular dysfunction, PCI was associated with a significantly lower incidence of cardiovascular events and improved functional recovery compared with OMT alone, without increased procedural risk. These findings support the role of revascularization in appropriately selected ILVD patients, particularly when guided by myocardial viability assessment. Larger multicenter trials with extended follow-up are warranted to confirm these outcomes in South Asian populations.