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[Transluminal coronary angioplasty in patients with left ventricular dysfunction; immediate and long term results]
D Beurrier1, O Tricoche, L Feldmann
1Service de cardiologie A, CHU Nancy-Brabois, Vandoeuvre-lès-Nancy.
Insights
Transluminal coronary angioplasty in patients with reduced left ventricular ejection fraction shows a 72% success rate. Long-term survival is impacted by triple-vessel disease, ejection fraction, and female gender.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Context:
- Transluminal coronary angioplasty (TCA) is increasingly utilized in patients with left ventricular dysfunction.
- Limited data exists on the outcomes of TCA in this specific patient group.
- Left ventricular ejection fraction (LVEF) is a critical indicator of cardiac function.
Purpose:
- To evaluate the immediate and long-term results of transluminal coronary angioplasty in patients with LVEF ≤ 35%.
- To identify prognostic factors influencing long-term mortality after TCA in this cohort.
Summary:
- This retrospective study analyzed 90 patients with LVEF ≤ 35% undergoing TCA between 1980 and 1992.
- A primary success rate of 77% was achieved, with a 72% overall procedural success rate and 5.5% hospital mortality.
- Long-term follow-up (mean 53 months) revealed a total mortality of 19%, with independent predictors of mortality including triple-vessel disease, LVEF, and female gender.
Impact:
- The findings provide crucial insights into the efficacy and risks of TCA for patients with impaired left ventricular function.
- Identifies key prognostic factors to guide clinical decision-making and patient counseling.
- Highlights the importance of considering coronary anatomy and patient demographics in managing this high-risk population.
Abstract:
Transluminal coronary angioplasty is increasingly performed in patients with left ventricular dysfunction. However, there is little data available concerning the outcome of these patients. The aim of this retrospective study was to assess the immediate and long-term results in 90 patients (76 men and 14 women) with left ventricular ejection fractions < or = 35% (average 29 +/- 5%) undergoing angioplasty between 1980 and December 1992. Eighty-seven patients (96%) had a history of infarction, 27 (30%) had already at least one episode of left ventricular failure and 34 (38%) had unstable angina at the time of angioplasty. The coronary disease was usually multi-vessel. A total of 118 lesions were dilated with a primary success rate of 77% (91/118): 86% (82/95) in non-occlusive stenoses and 39% (9/23) in complete obstructions. The total success rate per procedure was 72% (65/90) with a hospital mortality rate of 5.5% (5 cases). The mean follow-up period was 53 +/- 47 months. Twelve patients died during this period and two were lost to follow-up. The total and cardiovascular mortality at the end of the study was 19% (17/88). Eight of the 71 survivors underwent another revascularisation procedure (4 bypasses and 4 angioplasties); 21 (29%) have stable angina, 50 (71%) have no anginal pain and 61 (86%) have antianginal treatment. The probability of survival at one and four years was 81 +/- 4% and 79 +/- 5%, respectively. A multivariate analysis using the Cox model showed three independent prognostic factors for long-term mortality: triple coronary vessel disease, the best predictive factor, left ventricular ejection fraction and female gender.(ABSTRACT TRUNCATED AT 250 WORDS)