Related Experiment Videos
Long-term follow-up results after plain balloon coronary angioplasty
D S Gambhir1, R Sudha, S Singh
1Department of Cardiology, GB Pant Hospital, New Delhi.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) offers excellent long-term outcomes for coronary artery disease patients. This study shows sustained event-free survival and reduced major adverse cardiac events after PTCA.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Coronary artery disease (CAD) remains a leading cause of mortality worldwide.
- Percutaneous transluminal coronary angioplasty (PTCA) is a common revascularization strategy for CAD.
- Long-term outcomes and predictors of success after PTCA require continued investigation.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of plain balloon angioplasty in patients with coronary artery disease.
- To assess event-free survival and freedom from major adverse cardiac events (MACE) after PTCA.
- To identify patient subgroups that may benefit more or less from PTCA.
Main Methods:
- A retrospective analysis of 571 patients with CAD who underwent PTCA between 1987 and 1992.
- Kaplan-Meier survival analysis was used to determine event-free survival and freedom from MACE.
- Subgroup analyses were performed based on patient demographics, clinical presentation, and disease severity.
Main Results:
- PTCA was successful in 91.8% of patients, with a mean follow-up of 89 months.
- Ten-year event-free survival was 55.6%, and freedom from MACE was 75.4%.
- Patients with stable angina showed significantly better event-free survival and freedom from MACE compared to those with unstable angina.
Conclusions:
- Plain balloon angioplasty provides excellent long-term results for patients with coronary artery disease.
- PTCA significantly reduces major adverse cardiovascular events and the need for subsequent revascularization.
- Stable angina patients demonstrate superior long-term outcomes following PTCA compared to unstable angina patients.
Abstract:
Between September 1987 and June 1992, 571 patients of coronary artery disease underwent percutaneous transluminal coronary angioplasty in our institute. Their ages ranged from 31-82 years (mean 51 +/- 9) and majority (88.3%) were males. At baseline, 318 (55.7%) patients had chronic stable angina, 184 (32.2%) unstable angina, and 57 (10%) underwent PTCA for recurrence of angina in the post-infarction period. Single vessel angioplasty was performed in 406 (71.1%), two-vessel angioplasty in 121 (21.2%) and three or more vessels were dilated in 44 (7.7%). The procedure was successful in 524 (91.8%) patients. Follow-up was available in 438 (83.6%) patients, and ranged from 78 to 135 months (mean 89 +/- 29) with all the patients completing at least 60 months of follow-up. Using Kaplan-Meier statistical analysis, event-free survival (freedom from repeat percutaneous transluminal coronary angioplasty, myocardial infarction, coronary artery bypass surgery, or death) was 72.5 percent at three, 68.0 percent at five, 61.8 percent at seven and 55.6 percent at 10 years of follow-up. Freedom from major adverse cardiac events (myocardial infarction, coronary artery bypass surgery or death) was 88.3, 85.8, 82.0 and 75.4 percent at 3, 5, 7 and 10 years, respectively. Overall survival was 97.4 and 95.2 percent, respectively at 5 and 10 years. Subgroup analysis for all major events was done between males and females, diabetics and non-diabetics, previous history or absence of myocardial infarction, stable versus unstable angina and single versus multivessel disease. Event-free survival rates were compared between the groups using log rank test. On follow-up, the need for surgical revascularisation was more in males compared to females although statistically insignificant, and in patients with unstable angina compared to stable angina (p < 0.02). Similarly, freedom from major adverse cardiac events was significantly better in females compared to males (p < 0.05) and in stable versus unstable angina (p < 0.01). Event-free survival (repeat percutaneous transluminal coronary angioplasty, myocardial infarction, coronary artery bypass surgery, death) was also significantly better in patients with stable angina (p < 0.02). The other outcomes were comparable in all the subgroups. In conclusion, plain balloon angioplasty provides excellent long-term results in patients with coronary artery disease in terms of reduction in major adverse cardiovascular events and need for subsequent revascularisation.