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Safety and efficacy of percutaneous transluminal coronary angioplasty in patients with left ventricular dysfunction
T Stevens1, J K Kahn, B D McCallister
1Mid America Heart Institute, St. Luke's Hospital, Kansas City, Missouri.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) in patients with left ventricular (LV) dysfunction shows increased procedural risks but offers effective long-term outcomes for coronary artery disease management.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Left ventricular (LV) dysfunction is a significant risk factor in patients with coronary artery disease.
- The efficacy and safety of percutaneous transluminal coronary angioplasty (PTCA) in this high-risk population require thorough investigation.
Purpose of the Study:
- To evaluate the risks and long-term outcomes of elective PTCA in patients with LV dysfunction (ejection fraction ≤ 40%).
- To compare procedural results and long-term survival with patients who have preserved LV function (ejection fraction > 40%).
Main Methods:
- Retrospective analysis of 845 elective PTCA procedures in patients with LV dysfunction.
- Comparison with 8,117 PTCA procedures in patients with ejection fraction > 40%.
- Assessment of procedural success, mortality, myocardial infarction, need for revascularization, and actuarial survival up to 4 years.
Main Results:
- Patients with LV dysfunction were older and had more complex coronary artery disease.
- Angiographic success was slightly lower (93% vs. 95%), and procedural mortality was higher (4% vs. 1%) in the LV dysfunction group.
- At a mean follow-up of 33.5 months, 59% of patients with LV dysfunction were angina-free, with 1- and 4-year survival rates of 87% and 69%, respectively.
Conclusions:
- Despite increased procedural risks, PTCA can be an effective treatment for coronary artery disease in patients with LV dysfunction.
- Factors such as 3-vessel disease, older age, severe angina, and incomplete revascularization are associated with increased long-term mortality.
Abstract:
The risks and long-term outcome after 845 elective percutaneous transluminal coronary angioplasties (PTCA) in patients with left ventricular (LV) dysfunction (ejection fraction less than or equal to 40%) were examined. Procedural results were compared with 8,117 consecutive procedures in patients with ejection fractions greater than 40%. The patients with LV dysfunction were older (63 vs 60 years, p less than 0.01), had a greater incidence of prior myocardial infarction (84 vs 45%, p less than 0.001), prior bypass surgery (39 vs 21%, p less than 0.001), 3-vessel disease (62 vs 33%, p less than 0.001), and class IV angina (48 vs 41%, p less than 0.01) than the control group. Angiographic success was lower (93 vs 95%, p less than 0.01), and overall procedural mortality was increased ( 4 vs 1%, p less than 0.001) in the study group. Emergency surgery rates were identical (2%). No significant difference was found in rates of nonfatal Q-wave myocardial infarction (2 vs 1%). At mean follow-up of 33.5 months, 15% of the patients with LV dysfunction required late bypass surgery, 27% underwent repeat PTCA, and 59% were angina free. Actuarial survival at 1 and 4 years was 87 and 69%, respectively. Cox regression analysis identified 3-vessel disease, age greater than or equal to 70 years, class IV angina and incomplete revascularization as correlates of long-term mortality. These data suggest that PTCA may be an effective treatment for coronary artery disease in patients with LV dysfunction.