Angioplasty of the proximal left anterior descending coronary artery: Initial success and long-term follow-up

• Published in: Journal of the American College of Cardiology 1992-03, Vol.19 (4), p.745-751
• Main Authors: Frierson, John H., Dimas, Alexios P., Whitlow, Patrick L., Hollman, Jay L., Marsalese, Dominic L., Simpfendorfer, Conrad C., Dorosti, Khosrow, Franco, Irving
• Format: Article
• Language: English
• Subjects: Actuarial Analysis; Angioplasty, Laser; Coronary Artery Bypass; Coronary Disease - mortality; Coronary Disease - therapy; Female; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction - epidemiology; Recurrence; Risk Factors; Survival Rate; Time Factors
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(92)90512-L

From 1984 to 1987, 537 consecutive patients (mean age 58 years; range 34 to 79) underwent angioplasty for proximal left anterior descending coronary artery disease. The procidure was clinically successful in 516 (96.1%). Procedural complications included myocardial infarction (2.2%; Q wave 0.9%, non-Q wave 1.3%), in-hospital bypass surgery (3%) and death (0.4%). Follow-up was obtained in 534 patients (99.8%) for a mean duration of 44 months (range 8 to 75). Follow-up cardiac catheterization, performed in 391 patients (76%), demonstrated a 39.6% angiographic restenosis rate. Ninety-eight (19%) of the patients with a clinically successful result required additional revascularization for recurrent left anterior descending artery disease by angioplasty (12.8%) or coronary artery bypass grafting (4.7%), or both (1.5%). During follow-up there was a 2.5% incidence rate of myocardial infarction (anterior myocardial infarction 1.6%), and 27 patients (5.2%) died, 14 (2.7%) of cardiac causes. The actuarial 5-year cardiac survival rate was 97%, freedom from cardiac death and myocardial infarction was 94% and freedom from cardiac death, myocardial infarction, coronary artery bypass surgery and repeat left anterior descending artery angioplasty was 77%. At last follow-up 76% of patients were free of angina and 88% reported sustained functional improvement. Angioplasty is an effective treatment for prorimal left anterior descending coronary artery disease that has a high success rate, low incidence of procedural complications and provides excellent long-term cardiac survival, freedom fron cardiac events and sustained functional improvement.