title: Angioplasty of the proximal left anterior descending coronary artery: initial success and long-term follow-up.
abstract: From 1984 to 1987, 537 consecutive patients (mean age 58 years; range 34 to 79) underwent angioplasty for proximal left anterior descending coronary artery disease. The procedure was clinically successful in 516 (96.1%). Procedural complications included myocardial infarction (2.2%; Q wave 0.9%, non-Q wave 1.3%), in-hospital bypass surgery (3%) and death (0.4%). Follow-up was obtained in 534 patients (99.8%) for a mean duration of 44 months (range 8 to 75). Follow-up cardiac catheterization, performed in 391 patients (76%), demonstrated a 39.6% angiographic restenosis rate. Ninety-eight (19%) of the patients with a clinically successful result required additional revascularization for recurrent left anterior descending artery disease by angioplasty (12.8%) or coronary artery bypass grafting (4.7%), or both (1.5%). During follow-up there was a 2.5% incidence rate of myocardial infarction (anterior myocardial infarction 1.6%), and 27 patients (5.2%) died, 14 (2.7%) of cardiac causes. The actuarial 5-year cardiac survival rate was 97%, freedom from cardiac death and myocardial infarction was 94% and freedom from cardiac death, myocardial infarction, coronary artery bypass surgery and repeat left anterior descending artery angioplasty was 77%. At last follow-up 76% of patients were free of angina and 88% reported sustained functional improvement. Angioplasty is an effective treatment for proximal left anterior descending coronary artery disease that has a high success rate, low incidence of procedural complications and provides excellent long-term cardiac survival, freedom from cardiac events and sustained functional improvement.
authors.affiliation: Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195-5066.
authors.forename: J H
authors.initials: JH
authors.lastname: Frierson
authors.forename: A P
authors.initials: AP
authors.lastname: Dimas
authors.forename: P L
authors.initials: PL
authors.lastname: Whitlow
authors.forename: J L
authors.initials: JL
authors.lastname: Hollman
authors.forename: D L
authors.initials: DL
authors.lastname: Marsalese
authors.forename: C C
authors.initials: CC
authors.lastname: Simpfendorfer
authors.forename: K
authors.initials: K
authors.lastname: Dorosti
authors.forename: I
authors.initials: I
authors.lastname: Franco
mesh_terms: D000206:Actuarial Analysis; D016342:Angioplasty, Laser; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D012008:Recurrence; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors