title: Predictors of improvement in left ventricular function after initially successful angioplasty of unprotected left main coronary artery stenoses.
abstract: BACKGROUND
  Percutaneous coronary intervention (PCI) has been increasingly applied to unprotected left main coronary artery (LMCA) lesions, with varied procedural success and clinical outcomes. However, the effect of PCI on left ventricular performance is still unclear, and there are no clinical studies assessing factors that influence left ventricular ejection fraction (LVEF) in these cases.
  
  
  METHODS
  Between April 1986 and August 2002, de novo PCI was performed for unprotected LMCA stenoses in 199 patients. Close clinical and angiographic follow-up were conducted after the procedure.
  
  
  RESULTS
  One hundred eighty patients survived over six months and analysis of paired left ventriculography was possible in 175 patients. Improvement in LVEF was observed in the entire population (52.9 +/- 15.7% to 56.1 +/- 14.3%, p = 0.048). The LVEF change was 6.7 +/- 9.5% (p < 0.01) in group with baseline LVEF < or = 50% and 0.7 +/- 6.7 % (p = NS) in group with LVEF > 50%. There was significant intergroup difference (p < 0.001). Patients with baseline diameter stenosis > or = 60% had an improvement of 5.3 +/- 8.3% (p < 0.05) whereas those with stenosis < 60% had no improvement (2.0 +/- 8.4%, p = NS). CK-MB elevation > or = 3 times normal after PCI had a significant inverse association with improvement in LVEF (p < 0.05). Multivariate analysis revealed baseline LVEF < or = 50% was the only independent predictor of improvement in LVEF (standard estimate = 3.509, 95% CI: 2.164-4.854, p < 0.001).
  
  
  CONCLUSIONS
  Successful PCI procedure is associated with significant improvement in LVEF, especially in patients with depressed left ventricular function.
authors.affiliation: Department of Cardiology, Shiga Medical Center for Adults, Moriyama, Shiga, Japan.
authors.forename: Fang-Bin
authors.initials: FB
authors.lastname: Hu
authors.forename: Hideo
authors.initials: H
authors.lastname: Tamai
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Kosuga
authors.forename: Eisho
authors.initials: E
authors.lastname: Kyo
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Hata
authors.forename: Masaharu
authors.initials: M
authors.lastname: Okada
authors.forename: Takuji
authors.initials: T
authors.lastname: Nakamura
authors.forename: Shinya
authors.initials: S
authors.lastname: Fujita
authors.forename: Takafumi
authors.initials: T
authors.lastname: Tsuji
authors.forename: Shinsaku
authors.initials: S
authors.lastname: Takeda
authors.forename: Seiichio
authors.initials: S
authors.lastname: Motohara
authors.forename: Hiromu
authors.initials: H
authors.lastname: Uehata
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017225:Atherectomy, Coronary; D023921:Coronary Stenosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function / Q000502:physiology*; D012720:Severity of Illness Index; D015607:Stents; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*