TY - JOUR
T1 - Coronary stenting in patients with depressed left ventricular function
T2 - Acute and long-term results in a selected population
AU - Di Sciascio, Germano
AU - Patti, Giuseppe
AU - D'Ambrosio, Andrea
AU - Nusca, Annunziata
PY - 2003/8/1
Y1 - 2003/8/1
N2 - Percutaneous coronary angioplasty (PTCA) in patients with depressed left ventricular ejection fraction (LVEF) is associated with increased acute and late mortality; in contrast to plain PTCA, results of stenting in these patients have not been characterized. To assess the current outcome of stenting in patients with LV dysfunction, results from 80 patients procedures were analyzed. Intervention for acute myocardial infarction (MI) was excluded; 21% of patients had unstable angina and 30% had a recent MI. Mean LVEF was 40 ± 9% (range, 25-45%). Multivessel revascularization was done in 25 patients (31%), with a total of 114 lesions treated. Prophylactic intra-aortic balloon pump was used in only two patients. Angiographic and clinical success was achieved in 79/80 patients (99%). There were no in-hospital deaths, one patient (1%) had a non-Q-wave MI, and no patients required emergency bypass surgery (CABG). All patients completed at least 6 months follow-up (mean, 30 ± 14 months): 64 patients (80%) remained asymptomatic, 4 (5%) had acute MI, and 5 (6%) died. In-stent restenosis occurred in five patients (6%); of these, three required repeat PTCA, three patients (4%) underwent subsequent elective CABG. Including patients with repeat intervention, 67 patients (84%) are clinically improved; actuarial event-free survival was 87% at 56-month follow-up. Thus, stenting in patients with impaired LVEF is associated with excellent outcome and lower mortality than previously reported for balloon angioplasty alone. Whether coronary stenting may be a therapeutic strategy equivalent to surgery in selected patients needs to be investigated in prospective randomized trials.
AB - Percutaneous coronary angioplasty (PTCA) in patients with depressed left ventricular ejection fraction (LVEF) is associated with increased acute and late mortality; in contrast to plain PTCA, results of stenting in these patients have not been characterized. To assess the current outcome of stenting in patients with LV dysfunction, results from 80 patients procedures were analyzed. Intervention for acute myocardial infarction (MI) was excluded; 21% of patients had unstable angina and 30% had a recent MI. Mean LVEF was 40 ± 9% (range, 25-45%). Multivessel revascularization was done in 25 patients (31%), with a total of 114 lesions treated. Prophylactic intra-aortic balloon pump was used in only two patients. Angiographic and clinical success was achieved in 79/80 patients (99%). There were no in-hospital deaths, one patient (1%) had a non-Q-wave MI, and no patients required emergency bypass surgery (CABG). All patients completed at least 6 months follow-up (mean, 30 ± 14 months): 64 patients (80%) remained asymptomatic, 4 (5%) had acute MI, and 5 (6%) died. In-stent restenosis occurred in five patients (6%); of these, three required repeat PTCA, three patients (4%) underwent subsequent elective CABG. Including patients with repeat intervention, 67 patients (84%) are clinically improved; actuarial event-free survival was 87% at 56-month follow-up. Thus, stenting in patients with impaired LVEF is associated with excellent outcome and lower mortality than previously reported for balloon angioplasty alone. Whether coronary stenting may be a therapeutic strategy equivalent to surgery in selected patients needs to be investigated in prospective randomized trials.
KW - Coronary artery disease
KW - Coronary stenting
KW - Left ventricular dysfunction
UR - http://www.scopus.com/inward/record.url?scp=0042031491&partnerID=8YFLogxK
U2 - 10.1002/ccd.10533
DO - 10.1002/ccd.10533
M3 - Article
SN - 1522-1946
VL - 59
SP - 429
EP - 433
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 4
ER -