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[The effect of PTCA on clinical outcome in patients with coronary single vessel disease]
H J Rupprecht1, R Brennecke, R Erbel
1II. Medizinische Klinik, Johannes-Gutenberg-Universität, Mainz.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) significantly reduces serious cardiac events and bypass surgeries in single-vessel disease patients. Repeat PTCA may be necessary for restenosis, but overall outcomes improve.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Clinical Outcomes Research
Context:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common intervention for coronary artery disease.
- Evaluating long-term outcomes is crucial for optimizing treatment strategies.
- This study compares PTCA outcomes against a control group with unsuccessful initial procedures.
Purpose:
- To evaluate the 3-year clinical follow-up of patients undergoing PTCA for single-vessel disease.
- To compare the rate of serious cardiac events between patients who underwent successful PTCA and those with unsuccessful procedures.
- To assess the need for repeat interventions and symptom-free survival.
Summary:
- A 3-year follow-up of 53 patients who underwent PTCA (PTCA-group) was compared to 53 patients with failed PTCA (control-group).
- The PTCA-group experienced significantly fewer deaths (0% vs 5.7%), myocardial infarctions (3.8% vs 5.7%), and coronary artery bypass grafting (9.4% vs 32.1%).
- Overall serious cardiac events were markedly reduced in the PTCA-group (13.2% vs 43.4%), though repeat PTCA was needed for restenosis in 28.3% of cases.
Impact:
- PTCA demonstrates a significant reduction in major adverse cardiac events and the need for coronary artery bypass grafting in single-vessel disease.
- The findings highlight the effectiveness of PTCA in improving patient outcomes.
- Consideration of repeat PTCA procedures for restenosis is important for long-term management.
Abstract:
We evaluated a 3-year clinical follow-up in 53 patients with unsuccessful PTCA, due to failure to reach the lesion (control-group) in comparison to a "matched pairs" group of 53 patients, in whom PTCA had been performed (PTCA-group). There were no deaths in the PTCA-group compared to 3 deaths (5.7%) in the control-group (ns). Two patients (3.8%) and three patients (5.7%), respectively, suffered an acute transmural myocardial infarction during the follow-up period (ns). Coronary artery bypass grafting (CABG) had been performed in five patients (9.4%) following PTCA, and in 17 patients (32.1%) of the control-group (p less than 0.002). The overall rate of serious cardiac events (death, myocardial infarction or CABG) amounted to 13.2% (seven patients) in the PTCA-group and to 43.4% (23 patients) in the control-group (p less than 0.002). Only in the PTCA-group was a repeat PTCA performed in 15 patients (28.3%) with restenosis (p less than 0.00003). 35 of 53 patients in the PTCA-group (66%) and 27 of 50 survivors in the control-group were free of symptoms at the end of follow-up (ns). These results demonstrate that PTCA in patients with single-vessel disease is followed by a marked reduction of serious cardiac events, predominantly of bypass-operations, but the necessity of a second PTCA-procedure in case of restenosis has to be considered.