PERCUTANEOUS CARDIOPULMONARY BYPASS-SUPPORTED CORONARY ANGIOPLASTY INPATIENTS WITH UNSTABLE ANGINA-PECTORIS OR MYOCARDIAL-INFARCTION AND ALEFT-VENTRICULAR EJECTION FRACTION LESS-THAN-OR-EQUAL-TO-25-PERCENT

The objective of this study was to determine the acute and long-term r esults of percutaneous cardiopulmonary bypass-supported angioplasty in treating higk-risk patients with unstable presentations and severely pressed left ventricular (LV) function (ejection fraction [EF] less th an or equal to 25%). One hundred seven consecutive patients with a mea n LVEF of 19 +/- 3% were studied. Seventy-four patients (69%) had unst able angina, 60 (56%) had New York Heart Association class III or IV s ymptoms, 74 (69%) had recent (<15 days) documented acute myocardial in farction, 103 (96%) had 3-vessel disease, and 58 (54%) had only 1 rema ining patent artery. A total of 50 patients (47%) were deemed unsuitab le for bypass surgery. Of 196 severe narrowings attempted in 166 coron ary arteries, 193 (98%) were successfully dilated in 105 patients (98% ), and there was no procedure-related mortality, Q-wave myocardial inf arction, or urgent requirement for coronary bypass surgery. There were 5 in-hospital deaths (4.7%) and the remaining 102 patients have been followed for 24.5 +/- 1.3 (mean +/- SE) months. Twenty-three patients (21%) died between 1 and 23 months after the procedure. One- and 2-yea r survival free of cardiac death was 83% and 77%, respectively. Of the 79 surviving patients, 65 have survived event free of myocardial infa rction and revascularization; event free survival for 1 and 2 years wa s 76% and 69.5%, respectively. In the 64 patients in whom LV function was measured before and after the procedure, global EF increased from 20.6% to 29.3% (p <0.001). patients who remained event free had a grea ter improvement in LVEF than those who had a cardiac event during foll ow-up (p <0.05). Thus, this study demonstrates the safety and efficacy of percutaneous cardiopulmonary bypass-supported angioplasty in the i mmediate treatment of high-risk unstable patients with multivessel cor onary artery disease and severely depressed LV function.