10-YEAR FOLLOW-UP OF PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY FOR PROXIMAL LEFT ANTERIOR DESCENDING CORONARY-ARTERY STENOSIS IN 351 PATIENTS

Objectives. We sought to evaluate the short- and long-term results of balloon angioplasty for stenoses in the proximal left anterior descend ing coronary artery. Background. Both the supposedly high rate of acut e complications and relatively poor long-term results of balloon angio plasty for stenoses in the proximal left anterior descending coronary artery have led to a search for alternative interventional techniques. Methods. We analyzed the success rates and long-term follow-up result s in 351 consecutive patients who underwent balloon angioplasty for st enosis of the left anterior descending coronary artery proximal to its first side branch. The power of the study was >80% in detecting a dif ference of 9% in the proportion of patients who survived at 10 Sears, assuming an 80% survival rate in the control group. Results. There wer e 60 ostial and 291 nonostial stenoses. Follow-up lasted a median of 8 5 months (range 0 to 137) and was 100% complete. The angiographic succ ess rate was 90.9%. The clinical success rate was 86.3%. Nine patients (2.6%) died, 17 (4.8%) needed emergency coronary artery bypass graft surgery, and 10 (2.8%) developed a myocardial infarction. Several pati ents had subsequent complications. The success and complication rates were not significantly different for patients with ostial and nonostia l stenoses. Ten gears after balloon angioplasty, freedom from mortalit y was 80%, freedom from cardiac death was 87%, freedom from myocardial infarction was 84%, freedom from vessel related reinterventions was 6 6%, and freedom from angina pectoris was 33%. There were more reinterv entions for ostial stenoses, with a 1-year relative risk of ostial ver sus nonostial stenoses for related reinterventions of 1.7 (95% confide nce interval 1 to 2.8, p = 0.049). Conclusions. More than 10 years ago , balloon angioplasty for stenoses in the proximal left anterior desce nding coronary artery, either ostial or nonostial, had a high success rate. Although the long-term results are satisfactory, ostial stenoses are associated viith a higher early clinical restenosis rate requirin g more reinterventions.