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Percutaneous transluminal coronary angioplasty in King Chulalongkorn Memorial Hospital: a four-year experience
S Srimahachota1, W Udayachalerm, S Boonyaratavej
1Cardiac Center, King Chulalongkorn Memorial Hospital, Thailand.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) is a successful coronary intervention with a 91.5% success rate. This study shows PTCA offers a high success rate and minimal complications for treating coronary artery disease.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Vascular Surgery
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a key procedure for managing coronary artery disease.
- Evaluating the outcomes and complications of PTCA is crucial for clinical practice.
- This study analyzes a significant volume of PTCA cases from a single institution.
Purpose of the Study:
- To assess the success rate and complication profile of percutaneous transluminal coronary angioplasty (PTCA).
- To analyze patient demographics, indications, and procedural details of PTCA.
- To report on adjunctive procedures like stent implantation and rotational atherectomy.
Main Methods:
- Retrospective analysis of 461 percutaneous transluminal coronary angioplasty (PTCA) cases performed between January 1993 and December 1996.
- Data collected included patient characteristics, indications for PTCA, procedural details, success rates, and complications.
- Adjunctive procedures such as stent implantation and rotational atherectomy were also documented.
Main Results:
- A high success rate of 91.5% was achieved for PTCA, defined as residual diameter stenosis <50%.
- The overall complication rate was 6.9%, with specific events including abrupt closure (2.2%) and cerebral embolism (0.2%).
- Common indications included chronic stable angina (53%) and post-myocardial infarction angina (26.6%), with the left anterior descending artery being the most frequently dilated vessel (44.2%).
Conclusions:
- Percutaneous transluminal coronary angioplasty (PTCA) is a highly effective coronary interventional procedure.
- PTCA demonstrates a high success rate and a low incidence of significant complications.
- The findings support the continued use of PTCA in managing coronary artery disease.
Unlabelled:
From January 1993 to December 1996, 461 cases (743 lesions) of percutaneous transluminal coronary angioplasty (PTCA) were performed at King Chulalongkorn Memorial Hospital. Seventy eight per cent of the patients were male. Mean age was 61.1 +/- 9.6 yrs and mean ejection fraction was 0.59 +/- 0.18. The indications for PTCA were chronic stable angina (53%), post myocardial infarction (MI) angina (26.6%), unstable angina (17.4%) and acute MI (3%). Emergency PTCA was performed on 15 cases with 5 patients in cardiogenic shock. Fifty four per cent of the cases were performed in single vessel disease, 33 per cent in double vessel disease and 13 per cent in tripple vessel disease. The vessels dilated were the left anterior descending artery (44.2%), right coronary artery (27.8%), left circumflex artery (26.7%), left main (0.9%) and saphenous vein graft (0.4%). Mean balloon size was 2.48 mm. The overall success rate of PTCA, defined as residual diameter stenosis less than 50 per cent, was 91.5 per cent. In addition to PTCA, 123 stent implantations with mean stent size 2.98 mm and 15 rotational athrectomy were done in 114 cases. Complications of PTCA occurred in 32 cases (6.9%). Ten patients (2.2%) had abrupt closure, 1 of these needed emergency coronary bypass graft surgery (CABG). One patient (0.2%) had cerebral embolism with minor residual neurological deficit. One patient (0.2%) had toe gangrene which eventually needed amputation. One patient (0.2%) who presented with acute extensive anterior wall MI and failure of thrombolytic therapy died 8 hours after successful PTCA due to refractory cardiogenic shock. In the patients who also had stent implantation, there were 6 stent misplacements: 3 in the right femoral artery without any complication, 2 were misplacements in the coronary system and 1 dislodged in LM necessitating emergency CABG.
Conclusion:
PTCA is the coronary interventional procedure that can be performed with a high success rate and minimal complications.
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