Influence of left ventricular ejection fraction on the clinical outcome of percutaneous coronary interventions in heart transplant patients

Abstract Background Although cardiac allograft vasculopathy (CAV) represents a common complication in heart transplantation (HTX) recipients, data investigating predictors of prognosis in patients with CAV are limited. The study sought to investigate the prognostic impact of left ventricular ejection fraction (LVEF) undergoing percutaneous coronary intervention (PCI) in HTX recipients. Methods Patients with HTX who underwent PCI between January 2011 and June 2023 were included retrospectively at one center. Baseline characteristics, as well as lesion and interventional characteristics were compared between patients with LVEF > 50% and ≤ 50%, further risk stratification was performed comparing patients with LVEF ≥ 50, 41–49 and ≤ 40% and LVEF as continuous variable (per % increase). The primary endpoint was all-cause mortality at 3 years, the key secondary endpoint was major adverse cardiac and cerebrovascular events (MACCE). Results One hundred fifty-nine HTX recipients undergoing PCI were included with a median LVEF of 55% (i.e., LVEF > 50%: 67%; LVEF ≤ 50%: 33%). Patients with a reduced LVEF were younger (mean 54.1 vs. 59.3 years, p = 0.045), had a higher body mass index (mean 28.1 vs. 26.2 kg/m 2 , p = 0.012) and presented with a higher ISHLT class ( p < 0.001). In the adjusted analysis, a reduced LVEF was associated with lower technical (OR = 0.350; 95% CI 0.124 –0.991; p = 0.048) and procedural success (OR = 0.334; 95% CI 0.120 – 0.928; p = 0.035). Patients with a LVEF ≤ 50% had a higher risk of all-cause mortality at 3 years (42.31% vs. 19.63%, p = 0.003), which was still evident after multivariable adjustment (adjusted hazard ratio (HR) = 2.684; 95% CI 1.395 – 5.167; p = 0.003). In line, the risk of MACCE at 3 years was higher in patients with reduced LVEF (adjusted HR = 1.803; 95%CI 1.055—3.079; p = 0.031). Conclusion In patients undergoing PCI after HTX, a reduced LVEF was an independent predictor of lower technical and procedural success, and was independently associated with impaired long-term prognosis.