title: Safety and efficacy of percutaneous transluminal coronary angioplasty in patients with left ventricular dysfunction.
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.
authors.affiliation: Mid America Heart Institute, St. Luke's Hospital, Kansas City, Missouri.
authors.forename: T
authors.initials: T
authors.lastname: Stevens
authors.forename: J K
authors.initials: JK
authors.lastname: Kahn
authors.forename: B D
authors.initials: BD
authors.lastname: McCallister
authors.forename: R W
authors.initials: RW
authors.lastname: Ligon
authors.forename: S
authors.initials: S
authors.lastname: Spaude
authors.forename: B D
authors.initials: BD
authors.lastname: Rutherford
authors.forename: D R
authors.initials: DR
authors.lastname: McConahay
authors.forename: W L
authors.initials: WL
authors.lastname: Johnson
authors.forename: L V
authors.initials: LV
authors.lastname: Giorgi
authors.forename: T M
authors.initials: TM
authors.lastname: Shimshak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000401:mortality; D003327:Coronary Disease / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D013318:Stroke Volume; D015996:Survival Rate; D016277:Ventricular Function, Left