title: Improved survival for stenting vs. balloon angioplasty for the treatment of coronary artery disease in patients with ischemic left ventricular dysfunction.
abstract: While earlier studies of balloon angioplasty (BA) in patients with left ventricular (LV) dysfunction suggested high late mortality, a study directly comparing coronary stenting and BA has not been performed. Since stenting provides a more durable revascularization, we sought to compare long-term survival in patients undergoing stenting vs BA in patients with decreased left ventricular ejection fractions (LVEF). We evaluated consecutive patient procedures performed in our institution from 1996 through 1999. Patients were considered part of the stent group if they received at least one stent. To be included, patients had to have a technically adequate angiographic LV gram with a calculated LVEF<or=50%. Patients with prior CABG were excluded. Mortality data was retrieved using the United States Social Security Death Index. Follow-up ranged from 3.5 to 6.5 years. Statistical analysis was performed and tests were significant with a P-value<0.05. A total of 238 patients fulfilled our criteria. Mean age was 57.5+/-12 years, mean LVEF was 39+/-10%, 67% were males, 71.5% received stents, 62% had a recent MI, and 19% died during follow-up. Overall 5-year survival was 84% for stenting and 77% for BA (P=NS). Patients with an LVEF<or=40% (n=110) had better survival at 5 years if they received a stent compared with BA alone (76% for stents vs. 53% for BA; P<0.05). Stenting was found to be significant predictor of late survival on Cox Hazard Regression analysis in patients with an LVEF<or=50% and LVEF<or=40%. This study demonstrates improved 5-year survival for patients undergoing stenting compared with balloon angioplasty in patients with LVEF<or=40%.
authors.affiliation: Division of Cardiology, Virginia Commonwealth University Medical Center, Richmond, Virginia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lipinski
authors.forename: Robert E
authors.initials: RE
authors.lastname: Martin
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Cowley
authors.forename: Evelyne
authors.initials: E
authors.lastname: Goudreau
authors.forename: Walter N
authors.initials: WN
authors.lastname: Malloy
authors.forename: George W
authors.initials: GW
authors.lastname: Vetrovec
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000150:complications / Q000401:mortality* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013318:Stroke Volume; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology