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Coronary angioplasty for medically refractory unstable angina in patients with prior coronary bypass surgery
1Department of Cardiology, Denver Veterans Administration Medical Center, CO 80220.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) is effective for patients with unstable angina and prior bypass surgery. This study shows successful angioplasty outcomes in this specific patient group.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Vascular Surgery
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is established for unstable angina and post-bypass patients.
- The efficacy of PTCA in patients with both unstable angina and prior bypass surgery remains less evaluated.
Observation:
- This study analyzed 45 vessels in 34 patients with medically refractory unstable angina and prior bypass surgery.
- Patients presented with rest angina, ECG changes, and were on various medications, with some requiring hemodynamic support.
Findings:
- Successful angioplasty was achieved in most cases: 3 of 4 left internal mammary artery attempts, 16 of 17 vein grafts, and 22 of 24 native coronary arteries.
- No deaths or in-hospital myocardial infarctions were reported, indicating a safe procedure in this high-risk group.
Implications:
- PTCA is a viable and safe option for selected patients with complex coronary artery disease, including those with unstable angina and prior bypass.
- These findings support the use of interventional cardiology techniques in challenging patient populations.
Abstract:
Percutaneous transluminal coronary angioplasty (PTCA) has been applied with good results to selected patients with unstable angina and to selected patients who have had prior bypass surgery. The population with prior bypass and unstable angina has not been specifically evaluated. This report reviews the results of angioplasty of 45 vessels in 34 patients with medically refractory unstable angina and at least one prior bypass heart surgery. Of these 34 patients, 32 had rest angina; 14 had resting electrocardiographic changes, all 34 were on aspirin 325 mg QD, 31 were on a calcium blocker, 22 were on a beta blocker, 9 were on intravenous nitroglycerin, and 5 required intraaortic balloon counterpulsation for temporary stabilization. Angioplasty of a vein graft was attempted in 17 patients; the left internal mammary was attempted in 4 patients; 24 native coronary arteries in 15 patients were attempted; 3 of the native arteries were protected left main arteries. Of the LIMA angioplasties, 3 were successful; in the 1 unsuccessful case, the occluded anterior descending artery was opened. Of the 17 vein grafts, 16 were successful: 1 had an acute occlusive syndrome and went to surgery with a balloon pump and bail out catheter; his recovery was uneventful. Of the 24 native artery angioplasties, 22 were successful: one patient was technically unsuccessful in the only vessel attempted; he went to semiemergent surgery and recovered uneventfully. In the other, a right coronary lesion was successfully dilated, but an occluded anterior descending artery was not opened. There were no deaths or in-hospital myocardial infarctions.(ABSTRACT TRUNCATED AT 250 WORDS)