Outcome Of Percutaneous Coronary Intervention In Coronary Artery Disease With Severe Left Ventricular Dysfunction

Background: Patients with coronary artery disease and severe left ventricular dysfunction had a poor prognosis with medicine treatment. Previous studies suggested that coronary revascularization can improve survival, compared to medicine treatment, but the risks of Coronary Artery Bypass Graft(CABG) remained significant, particularly in patients with left ventricular dysfunction . Nowadays, technical advances in the field of interventional cardiology and increased operator experience have resulted in a substantial increase in the volume and complexity of procedures attempted. PCI is considered as a potentially safe and effective therapy for patients with left ventricular dysfunction. Objective: The purpose of the study was to access the safety and efficacy of PCI in patients with coronary artery disease (unstable angina and myocardial infarction) and severe left ventricular dysfunction who were not controlled by medicine treatment. Methods: The study included 42 patients with coronary artery disease (unstable angina and myocardial infarction) and severe left ventricular dysfunction(LVEF≤40%), who underwent PCI between June 2002 and December 2003.All patients were not controlled by medicine treatment and remained angina. The clinical data, procedural success, the complication and the outcome after PCI were analyzed. Results: The mean age of the 42 patients was 62±9 years,18 patients(43%) were over 70. 14 patients (33%),24 patients (58%) and 3 patients (7%) had unstable angina, a recent myocardial infarction and a previous myocardial infarction respectively,3 patients (7%) had diabetes mellitus. Mean LVEF was 0.30±0.08 (range, 0.19-0.40). 25 patients (60%) had multivessel coronary lesions, 16 patients (38%) had chronic total occlusion. Angiographic success was achieved in 90% of all patients, and the rate of completely revascularization was 67%. There were no in-hospital deaths, recurrent angina, myocardial infarction, and no patients required emergency CABG. 95% of patients completed one year follow-up. 3 patients had recurrent angina, of these , 2 required repeat PCI, 1 accepted CABG. 2 patients returned to hospital for recurrent heart failure. Cardiac death occurred in 3 patients. In the study, CCSA was improved from 3.35±0.69 to 2.29±1.2 (P<0. 0001), LVEF was increased from 0.30±0.08 to 0.35±0.05(P=0.02).One year survival was 93% and event-free survival was 78%. Conclusions : PCI results in significant clinical improvement and is safe and effective in patients with coronary artery disease(unstable angina and myocardial infarction) and severe left ventricular dysfunction, who are not controlled by medicine treatment.