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Direct results of percutaneous coronaryinterventions in patients with chronic ischemicheart disease and left ventricular dysfunction

Authors: Alekyan B.G.1, Buziashvili Yu.I.2, Golukhova E.Z.2, Bockeria O.L.2, Nikitina T.G.2, Petrosyan K.B.2, Abrosimov A.V.2, Ayvazyan G.G.2

Company: 1 A.V. Vishnevsky Institute of Surgery of Ministry of Health of the Russian Federation; Bol’shaya Serpukhovskaya ulitsa, 27, Moscow, 115478, Russian Federation;
2 Bakoulev National Scientific and Practical Center for Cardiovascular Surgery of Ministry of Health of the Russian Federation; Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

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DOI: https://doi.org/10.15275/kreatkard.2017.01.05

For citation: Alekyan B.G., Buziashvili Yu.I., Golukhova E.Z., Bockeria O.L., Nikitina T.G., Petrosyan K.B., Abrosimov A.V., Ayvazyan G.G. Direct results of percutaneous coronary interventions in patients with chronic ischemic heart disease and left ventricular dysfunction. Kreativnaya kardiologiya (Creative Cardiology, Russian journal). 2017; 11 (1): 45–55 (in Russ.). DOI: 10.15275/kreatkard.2017.01.05

Received / Accepted:  February 27, 2017 / March 10, 2017

Keywords: ischemic heart disease left ventricular dysfunction left ventricular ejection fraction 30% and less percutaneous coronary intervention

Full text:  

 

Abstract

Objective. To assess the immediate clinical and angiographic effectiveness of percutaneous coronary interventions (PCI) in patients with chronic ischemic heart disease and left ventricular dysfunction (EF 30% and less).
Material and methods. The basis of the material to put the immediate results of percutaneous coronary intervention in 112 patients with chronic coronary artery disease and left ventricular dysfunction (EF 30% and less), carried out in the period from 2008 to 2015, which was denied a coronary artery bypass surgery (CABG) in connection with a high surgical risk.
Results. 112 patients PCI performed on 240 (86%) of 279 hemodynamically significant lesions of the epicardial coronary arteries. Complete functional revascularization was performed in 62 (55.4%) and incomplete – in 50 (44.6%) patients. Angiographic success of PCI was 97.3%. In 3 (2.7%) patients after PCI remained residual stenosis of 20 to 40%, due to severe calcification of the coronary arteries. After PCI, angina functional class I was observed in 21 (18.8%) patients, II functional class – in 79 (70.5%), III functional class – in 12 (10.7%) patients. Clinical efficacy was achieved in 101 (90.2%) of the 112 patients. After successful PCI in patients showed an increase in left ventricular ejection fraction at the hospital stage to 26.1±3.9 to 35.1±16.9% (with fluctuation of 19 to 51%) in 8 (7.2%) patients during PCI complications were observed: 1 (0.9%) – developed acute stent thrombosis; in four (3.6%) patients had severe hypotension and bradycardia, which required additional intensive care measures; in three (2.7%) – has evolved pulsating hematoma, do not require surgery. There was no in-hospital mortality.
Сonclusion. PCI is a safe and effective treatment for patients with coronary artery disease and left ventricular dysfunction (EF 30% and less).

References

  1. Boсkeria L.A., Alekyan B.G., Buziashvili Yu.I.,Golukhova E.Z., Nikitina T.G., Zakaryan N.V.Endovascular surgery in patients with coronaryheart disease with low left ventricular ejection frac-tion. Guidelines for endovascular surgery of theheart and blood vessels. Vol. 3. Moscow: A.N.Bakoulev Scientific Center for CardiovascularSurgery of Russian Academy of Medical Sciences;2008: 514–5 (in Russ.). 
  2. Meza M.F., Kates M.A., Barbee R.W. et al.Combination of dobutamine and myocardial contrast echocardiography to differentiate postischemic from infracted myocardium. J. Am. Coll.Cardiol.1997; 29: 974–84.
  3. Lieberman A.N., Weiss J.L., Jugdutt B.I. et al.Two-dimensional echocardiography and infarctsize: retationship of regional wall motion andthickening to the extent of myocardial infarction inthe dog. Circulation. 1981; 63: 739–46.
  4. Burch G.E., Giles T.D., Colcolough H.L.Ischemic cardiomyopathy. Am. Heart J.1970; 79:291–2.
  5. Cohn J.N., Johnson G., Ziesche S. et al. A com-parison of enalapril with hydralazine-isosorbidedinitrate in the treatment of chronic congestiveheart failure. N. Engl. J. Med.1991; 325: 303–10.
  6. McKee P.A. The natural history of congestive heartfailure: the Framingam study. N. Engl. J. Med.1971; 285: 1441–6.
  7. Yusuf S., Pepine C.J., Garces C. Effect of enalaprilin myocardial infarction and unstable angina inpatients with low ejection fractions. Lancet. 1992;340: 1173–8.
  8. Montalescot G., Sechtem U., Achenbach S.ESC/EACTS Guidelines on myocardial revascu-larization. Eur. Heart J.2014; 35: 2569–70.
  9. Briguori C., Aranzulla T.C., Airoldi F., Cosgrave J.,Tavano D., Michev I. et al. Stent implantation inpatients with severe left ventricular systolic dys-function. Int. J. Cardiol.2009; 135 (3): 376–8
  10.  Nozari Y., Oskouei N.J., Khazaeipour Z. Effectof elective percutaneous coronary interventionon left ventricular function in patients with coro-nary artery disease. Acta Med. Iran.2012; 50 (1):26–30.
  11.  De Silva K., Webb I., Sicard P., Lockie T.,Pattinson S., Redwood S., Perera D. Does left ven-tricular function continue to influence mortalityfollowing contemporary percutaneous coronaryintervention? Cathet. Cardiovasc. Interv.2012;80 (5): 728–34. DOI: 10.1002/ccd.23465.
  12. Boсkeria L.A., Alekyan B.G., Buziashvili Yu.I.,Golukhova E.Z. et al. Coronary artery stenting inpatients with coronary heart disease with low leftventricular ejection fraction. Grudnaya i serdechno-sosudistaya khirurgiya. 2005; 6: 19–23 (in Russ.).
  13. Abugov S.A., Zhbanov I.V., Polyakov M.V., Pu-retskiy O.V., San’kov S.A., SaakyanYu.M. Myo-cardial revascularization in patients with coronaryartery disease with an initial left ventricular ejectionfraction less than 35%. Angiologiya i sosudistayakhirurgiya.2005; 3: 83–95 (in Russ.).
  14.  Kunadian V., Pugh A., Zaman A.G., Qiu W.Percutaneous coronary intervention among patientswith left ventricular systolic dysfunction: a reviewand meta-analysis of 19 clinical studies. Coron.Artery Dis.2012; 23 (7): 469–79.
  15. Daneault B., Généreux P., Kirtane A.J. et al.Comparison of three-year outcomes after primarypercutaneous coronary intervention in patientswith left ventricular ejection fraction <40% versus≥ 40% (from the HORIZONS-AMI trial). Am. J.Cardiol. 2013; 111 (1): 12–20.
  16. Serota H., Deligonal U., Lee W. et al. Predictors ofcardiac survival after percutaneous transluminalcoronary angioplasty in patients with severe leftventricular dysfunction. Am. J. Cardiol.1991; 67:367–72.
  17. Dudek D., Rzeszutko Ł., Turek P., Sorysz D. et al.Clinical predictors of left ventricular functionimprovement after percutaneous coronary inter-ventions in patients with ejection fraction below45%. Przegl. Lek. 2001; 58 (7–8): 751–4.
  18. Koleda N.V., Osiev A.G., Chernyavskiy A.M. Theimmediate results of coronary artery stenting inpatients with reduced left ventricular ejection frac-tion. Patologiya krovoobrashcheniya i kardiokhirur-giya. 2006; 2: 39–43 (in Russ.)
  19. Alidoosti M., Salarifar M., Zeinali A.M., KassaianS.E., Dehkordi M.R., Fatollahi M.S. Short- andlong-term outcomes of percutaneous coronaryintervention in patients with low, intermediate andhigh ejection fraction. Cardiovasc. J. Afr.2008;19 (1): 17–21.
  20.  Wallace T.W., Berger J.S., Wang A. et al. Impact ofleft ventricular dysfunction on hospital mortalityamong patients undergoing elective percutaneouscoronary intervention. Am. J. Cardiol.2009;103 (3): 355–60.

About Authors

  • Alekyan Bagrat Gegamovich, MD, DM, Асademician of Russian Аcademy of Sciences, Deputy Director for
  • Science and Technology Innovation;
  • Buziashvili Yuriy Iosifovich, Academician of Russian Academy of Sciences, Professor, Chief of Department;
  • Golukhova Elena Zelikovna, MD, DM, Academician of Russian Academy of Sciences, Professor, Chief of
  • Department;
  • Boсkeria Ol’ga Leonidovna, Professor, Corresponding Member of Russian Academy of Sciences, Chief Research
  • Associate, Deputy Chief of Department;
  • Nikitina Tat’yana Georgievna, MD, DM, Professor, Chief of Department;
  • Petrosyan Karen Valer’evich, MD, PhD, Chief of Department;
  • Abrosimov Andrey Viktorovich, MD, PhD, Junior Research Associate;
  • Ayvazyan Gurgen Gendrikovich, Cardiovascular Surgeon, Endovascular Surgeon

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


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