Angioplasty May Be Safer for Low-Risk Heart Disease Patients

Elective percutaneous coronary intervention (PCI) with drug-eluting stents (DES) could be a viable treatment option for low-risk patients with normal left ventricular function, according to a new study.

Researchers at the University of California, Los Angeles (UCLA; USA), the University of Padua (Italy), and other institutions analyzed data from a multicenter international registry, which included 221 consecutive patients from four institutions with normal left ventricular function who underwent elective unprotected left main coronary artery (ULMCA) PCI with DES from 2002 to 2009.

The results showed that the 30-day outcomes included no reports of cardiac death, stroke, reclogging of the artery or blood clots forming related to the stent; 7 patients (3%) experienced a periprocedural myocardial infarction (MI). Follow-up angiographs were available for 136 (62%) of the patients. At one year, the cumulative event-free survival rate for cardiac death was 97.7%, and the event-free rate for restenosis was 92.9%. Over the course of the study, 22 patients needed to be retreated due to restenosis, mostly during the first year of the study; of those patients, 14 underwent a repeat angioplasty and 8 had bypass surgery. At almost four years, 20 patients had died, of which 9 deaths were cardiac-related. The study was published in the June 2011 issue of the Journal Catheterization and Cardiovascular Interventions.

“Our analysis found that the short-term outcomes were excellent; patients who survived after the first year had very good long-term survival and a low incidence of retreatment,” said lead author Michael Lee, MD, an assistant professor of cardiology at the UCLA medical center.

The current standard of care for patients with ULMCA disease is coronary artery bypass graft (CABG) surgery, a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease (CAD). Arteries or veins from elsewhere in the patient's body are grafted to the coronary arteries to bypass atherosclerotic narrowings and improve the blood supply to the coronary circulation supplying the myocardium. PCI is recommended in clinical conditions that predict an increased risk of adverse surgical outcomes.

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University of California, Los Angeles
The University of Padua