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

Transluminal coronary angioplasty is increasingly performed in patients with left ventricular dysfunction. However, there is little data available concerning the outcome of these patients. The aim of this retrospective study was to assess the immediate and long-term results in 90 patients (76 men and 14 women) with left ventricular ejection fractions less than or equal to 35 % (average 29 +/- 5 %) undergoing angioplasty 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 total 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 complete obstructions. The total success rate per procedure was 72 % (65/90) with a hospital mortality rate of 5.5 % (5 cases). The mean follow-up period was 53 +/- 47 months. Twelve patients died during this period and two were lost to follow-up. The total and cardiovascular mortality at the end of the study was 19 % (17/88). Eight of the 71 survivors underwent another revascularisation procedure (4 bypasses and 4 angioplasties); 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 prognostic factors for long-term mortality: triple coronary vessel disease, 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-term survival despite slightly more complications than in the general population of angioplasty patients. The indications with respect to surgical revascularisation require further research, especially when the left ventricular ejection fraction is particularly low and the patient has triple vessel disease.