IS OCCLUSION OF ONE CORONARY-ARTERY A CON TRAINDICATION TO DILATATIONOF THE CONTROLATERAL ARTERY

Angioplasty of the dominant left anterior descending or right coronary arteries when the controlateral artery is occluded may lead to major left ventricular dysfunction or cardiogenic shock The authors assessed the results of angioplasty of a right coronary (n = 52) or left anter ior descending (n = 141) artery stenosis when the controlateral artery was occluded and the left circumflex had no significant stenosis in 1 93 patients. The immediate and late (33 +/- 18 months) results were co mpared in 3 groups : the study group, a reference surgical group in wh ich patients with comparable coronary lesions underwent double coronar y artery bypass and a reference angioplasty group (n = 194) in which p atients were treated by angioplasty of the right coronary and left ant erior descending arteries. The left ventricular function of the study group was normal or midly abnormal in 72 % of cases and moderately to severely abdnormal in 28 % of cases. During the hospital period, for t he study group, there were 5.7 % emergency coronary bypass procedures and 2.6 % non-emergency bypass procedures, 1.6 % of myocardial infarct ion and 0.5 % deaths. After hospital discharge, the study group had 13 .1 % of coronary bypass procedures, 3.7 % of myocardial infarcts and 4 .7 % deaths. The death and infarction rates were comparable in the 3 g roups. The study group had a higher incidence of coronary bypass surge ry in and after the hospital period than the control surgical group (p = 0.0.002). The authors conclude that dilatation of a main coronary a rtery when the controlateral artery is occluded is as safe as double c oronary artery bypass surgery and angioplasty of the two vessels. Inco mplete revascularisation in the study group did not affect survival ra te without myocardial infarction compared with the angioplasty and sur gical reference groups.