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[Percutaneous transluminal coronary angioplasty (PTCA) in unstable angina pectoris: results and complications with
H Seggewiss1, D Fassbender, U Gleichmann
1Kardiologische Klinik, Ruhr-Universität Bochum, Bad Oeynhausen.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) is effective for unstable angina but carries risks. Braunwald
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Medicine
Context:
- Unstable angina pectoris (UAP) is a critical condition requiring timely intervention.
- Percutaneous transluminal coronary angioplasty (PTCA) is a primary treatment for UAP.
- Predicting complications in UAP patients undergoing PTCA remains a clinical challenge.
Purpose:
- To evaluate the outcomes of PTCA in patients with unstable angina pectoris.
- To assess the efficacy and complication rates of PTCA based on UAP classification.
- To determine the utility of the Braunwald classification in stratifying PTCA risk.
Summary:
- A study of 168 UAP patients undergoing PTCA between 1989-1990 showed an 83.9% success rate.
- Major complications included one myocardial infarction (0.6%) and emergency coronary artery bypass grafting (CABG) in 9.5% of cases.
- Higher rates of emergency CABG were observed in Braunwald UAP class III (20.3%) and post-myocardial infarction subgroup C (30%) compared to class II (3.6%) and primary UAP subgroup B (6.9%).
Impact:
- The Braunwald classification system may help identify high-risk UAP patients undergoing PTCA.
- Risk stratification can guide treatment decisions and resource allocation for UAP management.
- Findings support personalized approaches to PTCA in UAP, considering patient subgroups.
Abstract:
Percutaneous transluminal coronary angioplasty (PTCA) of patients with unstable angina pectoris is an established therapy, although the rate of major complications (death, myocardial infarction, emergency coronary artery bypass operation) is higher than in patients with stable angina. This study analyzes the results of PTCA in 168 patients (136 men, 32 women, mean age 60.6 +/- 9.6 years) treated between January 1989 and June 1990 for unstable angina pectoris. Unstable angina was classified according to the criteria proposed by Braunwald in 1989. PTCA was successful in 141 patients (83.9%) and failed in 27 patients (16.1%). No patient died. One patient (0.6%) suffered an acute myocardial infarction related to PTCA. After failed PTCA 16 patients (9.5%) underwent emergency coronary artery bypass grafting (CABG), 10 patients had no complication. In patients of unstable angina class III (angina at rest within the last 48 h before PTCA) emergency CABG was needed in 20.3% compared to 3.6% (p less than 0.01) in patients with unstable angina class II (last attack of angina at rest more than 48 h before PTCA). Also 30% of patients with unstable angina within 2 weeks after myocardial infarction (clinical subgroup C) needed emergency CABG after failed PTCA as compared to only 6.9% (p less than 0.01) of patients with primary unstable angina pectoris without previous infarction (clinical subgroup B). The highest frequency (66.6%/6 of 9 patients) of emergency CABG was observed in patients with class III and subgroup C. We conclude that the classification of unstable angina pectoris proposed by Braunwald might be helpful to identify patients with risk in PTCA.(ABSTRACT TRUNCATED AT 250 WORDS)