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[Coronary angioplasty of moderate lesions (50 to 60%)]
L F Tanajura1, A G Sousa, F Feres
1Instituto Dante Pazzanese de Cardiologia, São Paulo.
Insights
Coronary angioplasty for moderate coronary lesions shows a high success rate. However, complications and restenosis rates are similar to severe lesions, suggesting reserved use for high-risk patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Coronary artery disease (CAD) is a leading cause of mortality worldwide.
- Percutaneous coronary intervention (PCI) is a common treatment for CAD.
- The efficacy of PCI for moderate coronary lesions requires further evaluation.
Purpose of the Study:
- To evaluate the effectiveness of transluminal coronary angioplasty (TCA) in patients with moderate coronary artery lesions (50-60% stenosis).
Main Methods:
- A cohort of 139 patients (108 male, mean age 55) with moderate coronary lesions underwent TCA between 1983 and 1989.
- Patients presented with stable (65%) or unstable angina (35%).
- The study included patients with single-vessel (84%) and two-vessel (16%) coronary artery disease.
Main Results:
- The primary success rate for TCA was 94% (130/139 patients).
- Complete revascularization was achieved in all patients with two-vessel disease.
- Late follow-up (mean 31 months) showed 71% asymptomatic patients, 23% with recurrent symptoms, and a 22% restenosis rate.
Conclusions:
- TCA for moderate coronary lesions demonstrates a high procedural success rate.
- Major complication and restenosis rates are comparable to those seen with severe coronary stenosis.
- The study suggests reserving TCA for moderate lesions to high-risk patients with evidence of myocardial ischemia.
Purpose:
To assess the efficacy of transluminal coronary angioplasty in patients with moderate (50-60%) coronary lesions.
Patients And Methods:
One hundred and thirty nine patients, 108 (78%) male, mean age was 55 years, who underwent coronary angioplasty from August 1983 to January 1989. Clinical findings included stable angina in 91 (65%) and unstable angina in 48 (35%). Single vessel disease was the case for 117 (84%), whereas 22 (16%) had two vessel coronary artery disease.
Results:
Primary success rate was 130 (94%). All patients with two vessel disease had complete revascularization. In the failure group there were 2 acute myocardial infarction (1.4%), and 4 (2.8%) emergency coronary artery by-pass surgery. There were no in-hospital deaths. Of the 130 patients with success, 119 (92%) had late follow-up (mean time 31 months). At the end of the follow-up period we found 85 (71%) asymptomatic, while 27 (23%) had recurrence of symptoms. There were 2 late cardiovascular deaths. Fifty four patients underwent late angiography and 42 (78%) had maintenance of the result while 12 (22%) had restenosis, with a mean degree more severe than pre-coronary angioplasty.
Conclusion:
Coronary angioplasty of moderate lesions has a high success rate (94%); nevertheless the rate of major complications and restenosis is very similar to that of coronary angioplasty for severe stenosis. Such findings led us to reserve the indication of coronary angioplasty for moderate lesions for patients at higher risk with clear evidence of myocardial ischemia.