Disease progression and adverse events in patients listed for elective percutaneous coronary intervention
1South West Cardiothoracic Centre, Derriford Hospital, Plymouth, PL6 8DH, UK.
Insights
Patients awaiting percutaneous coronary intervention (PCI) frequently experience disease progression and adverse events. However, myocardial infarction and death were rare during the waiting period.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Elective percutaneous coronary intervention (PCI) is a common procedure for managing coronary artery disease.
- Waiting lists for PCI can be lengthy, raising concerns about patient outcomes during this period.
Purpose of the Study:
- To prospectively record disease progression and the timing of adverse events in patients awaiting elective PCI.
- To assess the incidence of adverse coronary events and changes in disease severity during the waiting period for PCI.
Main Methods:
- An observational prospective study was conducted at a UK tertiary cardiothoracic centre.
- 145 patients awaiting elective PCI (October 1998 - September 1999) were monitored.
- Adverse events included death, myocardial infarction, unstable angina requiring admission, and emergency revascularization.
Main Results:
- Over a median follow-up of 10 months, 6.2% of patients experienced an adverse event.
- 20% of patients showed significant disease progression, with 7% requiring a switch to coronary artery bypass graft surgery.
- 11% of patients had symptom resolution, and 5.5% were admitted with unstable angina.
Conclusions:
- Significant disease progression and adverse events are common in patients awaiting PCI.
- While awaiting PCI, myocardial infarction and death were infrequent, and symptom resolution occurred in a notable proportion of patients.
- The dynamic nature of coronary artery disease necessitates careful management and potential treatment modification for patients on PCI waiting lists.
Objective:
To record disease progression and the timing of adverse events in patients on a waiting list for elective percutaneous coronary intervention (PCI).
Design:
Observational prospective study.
Settings:
A UK tertiary cardiothoracic centre, at a time when waiting lists for PCI were up to 18 months.
Patients:
145 patients (116 men, median age 59.5 years) placed on an elective waiting list for PCI between October 1998 and September 1999.
Main Outcome Measures:
Adverse events recorded were death, myocardial infarction, need for urgent hospital admission because of unstable angina, and need for emergency revascularisation while waiting for PCI.
Results:
During a median follow up of 10 months (range 1-18 months), nine (6.2%) patients experienced an adverse event. Eight (5.52%) patients were admitted with unstable angina as emergencies. One was admitted with a myocardial infarction. Twenty nine (20.0%) patients had significant disease progression at the time of the repeat angiogram before PCI. In 10 (7%), disease had progressed so that PCI was no longer feasible and patients were referred for coronary artery bypass graft. Sixteen (11%) were removed from the PCI waiting list because of almost complete resolution of their anginal symptoms.
Conclusion:
Adverse coronary events and clinically significant disease progression occur commonly in patients waiting for PCI. Despite the presence of severe coronary lesions, myocardial infarction was rare and no patients died while on the waiting list. Resolution of anginal symptoms was also comparatively common. The pathophysiology of disease progression frequently necessitates a change in the treatment of patients waiting for PCI.
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