Percutaneous Transluminal Coronary Angioplasty in Patients with Severely Depressed Left Ventricular Function

Abstract

Among nearly 2,000 consecutive percutaneous transluminal coronary angioplasty (PTCA) patients, 42 patients (36 male, 6 female; mean age 60 ± 11 years) with mainly unstable angina had ejection fractions of < 35% (mean 30 ± 5%). All patients had previous myocardial infarctions; 31 (= 74%) had multivessel disease. Successful procedure was achieved in 35 of the 42 (= 83%) patients, 31 of 35 (= 89%) stenoses could be successfully dilated and 9 of 15 (= 60%) occlusions reopened. In-hospital mortality was 2.4%. Follow-up angiography in 22 of the 35 patients who had been successfully treated showed significant improvement of ejection fraction from 29 ± 5 to 36 ± 7%. At clinical follow-up 19 ± 14 months (2-53 months) after the procedure, nearly all surviving patients were in anginal class I or II, 5 had died from cardiac and 1 from noncardiac causes. Thus, PTCA in patients with severely depressed left ventricular function shows acceptable acute results; attenuation of ventricular dysfunction and continued symptomatic improvement can be achieved. However, late outcome is significantly worse than in patients with normal ventricular function.

The Current and Future Role of Percutaneous Coronary Intervention in Patients with Coronary Artery Disease

“…The treatment of patients with ischemic left ventricular dysfunction has long posed a challenge to cardiologists due to their poor prognosis 24–26 . However, patients with low ejection fractions appear to benefit from revascularization, whether with CABG 27–29 or PCI 30,31 . The improvement in prognosis is most likely due to relieving ischemia, thus preventing further injury to viable myocardium and some improvement in global left ventricular (LV) function.…”

“…[24][25][26] However, patients with low ejection fractions appear to benefit from revascularization, whether with CABG [27][28][29] or PCI. 30,31 The improvement in prognosis is most likely due to relieving ischemia, thus preventing further injury to viable myocardium and some improvement in global left ventricular (LV) function. The extent to which LV function improves is dependent on the amount of viable myocardium [32][33][34] and the completeness of revascularization.…”