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Coronary stenting in patients with depressed left ventricular function: acute and long-term results in a selected
Germano Di Sciascio1, Giuseppe Patti, Andrea D'Ambrosio
1Department of Cardiovascular Sciences, Campus Bio-Medico University, Rome, Italy. g.disciascio@unicampus.it
Insights
Coronary stenting in patients with reduced left ventricular ejection fraction (LVEF) shows excellent outcomes, with lower mortality compared to balloon angioplasty alone. This study suggests stenting is a viable option for these high-risk patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Heart Failure
Background:
- Percutaneous coronary angioplasty (PTCA) in patients with reduced left ventricular ejection fraction (LVEF) is linked to higher mortality.
- The outcomes of coronary stenting in this specific patient group remain undercharacterized.
Purpose of the Study:
- To evaluate the outcomes of coronary stenting in patients with impaired left ventricular function.
- To compare stenting results with historical data from balloon angioplasty in similar patients.
Main Methods:
- Analysis of 80 patients with depressed LVEF (mean 40±9%) undergoing coronary stenting, excluding acute myocardial infarction interventions.
- Assessment of angiographic and clinical success, in-hospital events, and long-term follow-up including restenosis and mortality.
- Data collected on clinical status, repeat interventions, and actuarial event-free survival.
Main Results:
- High rates of angiographic and clinical success (99%) with no in-hospital deaths or need for emergency bypass surgery (CABG).
- At a mean follow-up of 30 months, 80% of patients remained asymptomatic, with a 5-year actuarial event-free survival of 87%.
- Mortality (6%) and in-stent restenosis (6%) were lower than anticipated, with 84% of patients showing clinical improvement after repeat interventions if needed.
Conclusions:
- Coronary stenting in patients with impaired LVEF is associated with excellent clinical outcomes and reduced mortality compared to historical PTCA data.
- Stenting appears to be a safe and effective revascularization strategy for selected patients with LV dysfunction.
- Further prospective randomized trials are warranted to compare coronary stenting directly with surgical revascularization in this population.
Abstract:
Percutaneous coronary angioplasty (PTCA) in patients with depressed left ventricular ejection fraction (LVEF) is associated with increased acute and late mortality; in contrast to plain PTCA, results of stenting in these patients have not been characterized. To assess the current outcome of stenting in patients with LV dysfunction, results from 80 patients procedures were analyzed. Intervention for acute myocardial infarction (MI) was excluded; 21% of patients had unstable angina and 30% had a recent MI. Mean LVEF was 40 +/- 9% (range, 25-45%). Multivessel revascularization was done in 25 patients (31%), with a total of 114 lesions treated. Prophylactic intra-aortic balloon pump was used in only two patients. Angiographic and clinical success was achieved in 79/80 patients (99%). There were no in-hospital deaths, one patient (1%) had a non-Q-wave MI, and no patients required emergency bypass surgery (CABG). All patients completed at least 6 months follow-up (mean, 30 +/- 14 months): 64 patients (80%) remained asymptomatic, 4 (5%) had acute MI, and 5 (6%) died. In-stent restenosis occurred in five patients (6%); of these, three required repeat PTCA, three patients (4%) underwent subsequent elective CABG. Including patients with repeat intervention, 67 patients (84%) are clinically improved; actuarial event-free survival was 87% at 56-month follow-up. Thus, stenting in patients with impaired LVEF is associated with excellent outcome and lower mortality than previously reported for balloon angioplasty alone. Whether coronary stenting may be a therapeutic strategy equivalent to surgery in selected patients needs to be investigated in prospective randomized trials.