Fifty-nine consecutive patients with coronary-artery disease undergoing percutaneous transluminal coronary angioplasty were evaluated with radionuclide ventriculography at rest and during exercise before angioplasty (when possible) and afterward, when it was successful. Thirty-eight patients (64 per cent) had an angiographically successful procedure. Three (5 per cent) had coronary occlusion as a complication. Arterial stenosis was reduced from 74±2 per cent to 31 ±3 per cent (mean ±S.E.M.). The mean ejection fraction was 55±2 per cent at rest and 51±3 per cent during exercise before the procedure. After successful angioplasty, the ejection fraction was unchanged at rest but increased to 62±2 per cent (P<0.001) during exercise. Regional dysfunction was present during exercise in 94 per cent of the patients before the procedure and in only 8 per cent after successful angioplasty. Of the 38 patients in whom the procedure was successful, 19 had sustained improvement for over six months, and eight for three to six months. Eleven patients had recurrence of symptoms; the second angioplasty was initially successful in nine. In 24 patients remaining asymptomatic for six months (19 after the first procedure and five after the second), the left ventricular ejection fraction during exercise remained stable or improved. (N Engl J Med. 1982; 306:441–6.) PERCUTANEOUS transluminal coronary angioplasty improves the angiographic appearance of coronary-artery stenoses and leads to symptomatic improvement.1 Although the improvement may be caused by an augmented capacity of the dilated coronary artery to deliver blood to previously ischemic myocardium, it is also possible that the salutary effects of this procedure are due to infarction of previously ischemic tissue, to disruption of neural afferent pathways, or to a placebo effect. We therefore designed a study to determine whether the amelioration of symptoms after coronary angioplasty occurred because the procedure increased functionally important myocardial blood now. Radionuclide ventriculography2,3 permits assessment of left ventricular.
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