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Survival after percutaneous transluminal coronary angioplasty in patients with severe left ventricular dysfunction
L Maiello1, A Colombo, R Gianrossi
1Catheterization Laboratory, Centro Cuore Columbus, Milan, Italy.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) in severe left ventricular dysfunction patients shows high acute complications and mortality. Triple-vessel disease patients face increased risks without long-term benefits from PTCA.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Severe left ventricular dysfunction poses significant challenges in managing coronary artery disease.
- Patients with reduced ejection fraction often experience worse outcomes after cardiac interventions.
Purpose of the Study:
- To evaluate the efficacy and safety of percutaneous transluminal coronary angioplasty (PTCA) in patients with severe left ventricular dysfunction.
- To identify risk factors and outcomes associated with PTCA in this high-risk patient population.
Main Methods:
- Analysis of 100 patients with left ventricular function <= 0.35 undergoing PTCA between 1987 and 1991.
- Assessment of angiographic success, in-hospital complications, clinical outcomes, and long-term mortality.
- Stratification of outcomes based on coronary artery disease severity (single, double, triple-vessel disease).
Main Results:
- Overall angiographic success rate was 84%.
- In-hospital mortality was 9%, with major complications more frequent in triple-vessel disease patients.
- Clinical success was achieved in 75% of patients, often with incomplete revascularization. Long-term mortality was significant.
Conclusions:
- PTCA in severe left ventricular dysfunction is associated with high acute complication and late mortality rates.
- Triple-vessel disease represents a high-risk subset with no demonstrated long-term benefit from PTCA.
- Careful patient selection and risk stratification are crucial for interventions in this population.
Abstract:
To assess the effects of coronary angioplasty in patients with severe left ventricular dysfunction, the results of procedures, performed between 1987 and 1991, in 100 patients (90 male) with left ventricular function < or = 0.35 (range, 0.20 to 0.35) and anginal symptoms were analyzed. Mean age was 62 +/- 10 years (range, 38 to 85 years). Ninety-five patients had previous myocardial infarction and 27 patients had previous coronary artery bypass grafting. Unstable angina was present in 81 percent of patients. Single-vessel disease was present in 6 patients, double vessel was present in 31 patients, and triple-vessel disease was present in 63 patients. Percutaneous transluminal coronary angioplasty (PTCA) was attempted on 164 vessels, 27 of these with chronic total occlusion. The overall angiographic success rate was 84 percent. Myocardial infarction occurred in four patients, six patients underwent urgent coronary bypass surgery, and seven patients died of cardiac causes. There was a 9 percent incidence of total in hospital mortality. Major complications were significantly more frequent in patients with triple-vessel disease. Clinical success was achieved in 75 patients, 55 of these with incomplete revascularization. Long-term follow-up (mean, 19 +/- 7 months) was available in all patients with clinical success. Thirteen patients had repeated PTCA, 8 patients had coronary surgery, and 13 patients died. In conclusion, in patients with severe left ventricular dysfunction, acute complications and late mortality rate are high. Patients with triple-vessel disease are a higher risk subset and have no long-term benefits by PTCA.