Clinical Phenotypes of Patients With Ischemic Cardiomyopathy After Percutaneous Coronary Intervention

Abstract

Background: Percutaneous coronary intervention (PCI) is a good option for patients with ischemic cardiomyopathy (ICM) at high operative risk. However, evidence shows little benefit of PCI, potentially due to heterogeneity in ICM. Here, we applied latent class analysis (LCA) to clinical data to characterize ICM phenotypes based on clinical features and to assess differences in clinical outcomes.

Methods and Results: LCA was performed on data from 492 patients with a left ventricular (LV) ejection fraction <50% who underwent PCI. Primary outcomes included all-cause mortality and heart failure (HF) hospitalization. The optimal number of clinical phenotypes was 3. Phenotype 1 (n=101) was characterized by severe chronic kidney disease and a high frequency of hemodialysis. Phenotype 2 (n=192) included men with early-onset ICM, a high frequency of lifestyle-related diseases, and a high body mass index. Phenotype 3 (n=199) included older adults with a high prevalence of atrial fibrillation, moderate/severe mitral regurgitation, and high B-type natriuretic peptide levels. The risk of combined all-cause mortality and HF hospitalization was significantly lower for Phenotype 2 than the other phenotypes. LV reverse remodeling (LVRR) was associated with a lower incidence of the primary outcome in Phenotype 3, but not in the other phenotypes.

Conclusions: We identified differences in clinical outcomes and LVRR across clinical ICM phenotypes after PCI, suggesting distinct underlying mechanisms across ICM phenotypes that may benefit from targeted treatments.