Predictors of improvement in left ventricular function after initially successful angioplasty of unprotected left main coronary artery stenoses.
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.
Hu
Fang-Bin
FB
Department of Cardiology, Shiga Medical Center for Adults, Moriyama, Shiga, Japan.
Tamai
Hideo
H
Kosuga
Kunihiko
K
Kyo
Eisho
E
Hata
Tatsuhiko
T
Okada
Masaharu
M
Nakamura
Takuji
T
Fujita
Shinya
S
Tsuji
Takafumi
T
Takeda
Shinsaku
S
Motohara
Seiichio
S
Uehata
Hiromu
H
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*