Percutaneous transluminal coronary angioplasty in patients with severely depressed left ventricular function.

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 < or = 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.