Editorial Comment Therapeutic Choices in the Patient With Coronary Artery Disease and Left Ventricular Dysfunction

tute percutaneous transluminal coronary angio-plasty (PTCA) results for patients with depressed left ventricular function. The report describes the experi-ence of 15 collaborating centers that enrolled patients in the registry during a 9-month period in 1985 and 1986. The clinical investigators should be congratulated for providing a snapshot of their clinical experience. The report contributes some important pieces to the clini-cian's puzzle of how to manage patients with coronary artery disease and left ventricular dysfunction. A num-ber of pieces of the puzzle, however, remain missing. See p 21 Holmes and his colleagues have shown that PTCA can be performed in a number of centers with excellent short-term results, even in patients at increased risk because of depressed left ventricular function. Short-term complication rates were very similar to those observed in registry patients with normal left ventricu-lar function. Long-term results were also impressive (an 87 % 4-year survival rate) and better than reported in other series.2-4 This difference, however, may reflect, at least in part, different patient populations as suggested by the lower mean ejection fractions of the other reported series. A strong gradation in survival in PTCA patients based on left ventricular function was shown i