TRANSLUMINAL CORONARY ANGIOPLASTY IN PATI ENTS WITH LEFT-VENTRICULAR DYSFUNCTION - IMMEDIATE AND LONG-TERM RESULTS

Transluminal coronary angioplasty is increasingly performed in patient s with left ventricular dysfunction. However, there is little data ava ilable concerning the outcome of these patients. The aim of this retro spective study was to assess the immediate and long-term results in 90 patients (76 men and 14 women) with left ventricular ejection fractio ns less than or equal to 35 % (average 29 +/- 5 %) undergoing angiopla sty between 1980 and December 1992. Eighty-seven patients (96 %) had a history of infarction, 27 (30 %) had already at least one episode of left ventricular failure and 34 (38 %) had unstable angina at the time of angioplasty. The coronary disease was usually multi-vessel. A tota l of 118 lesions were dilated with a primary success rate of 77 % (91/ 118) : 86 % (82/95) in non-occlusive stenoses and 39 % (9/23) in compl ete obstructions. The total success rate per procedure was 72 % (65/90 ) with a hospital mortality rate of 5.5 % (5 cases). The mean follow-u p period was 53 +/- 47 months. Twelve patients died during this period and two were lost to follow-up. The total and cardiovascular mortalit y at the end of the study was 19 % (17/88). Eight of the 71 survivors underwent another revascularisation procedure (4 bypasses and 4 angiop lasties); 21 (29 %) have stable angina, 50 (71 %) have no anginal pain and 61 (86 %) have antianginal treatment; The probability of survival at one and four years was 81 +/- 4 % and 79 +/- 5 %, respectively. A multivariate analysis using the Cox model showed three independent pro gnostic factors for long-term mortality: triple coronary vessel diseas e, the best predictive factor, left ventricular ejection fraction and female gender. These results suggest that coronary angioplasty may be considered as treatment of first intention in patients with poor left ventricular function, with effective results and satisfactory long-ter m survival despite slightly more complications than in the general pop ulation of angioplasty patients. The indications with respect to surgi cal revascularisation require further research, especially when the le ft ventricular ejection fraction is particularly low and the patient h as triple vessel disease.