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Coronary angioplasty of diffuse coronary artery disease
E Goudreau1, G DiSciascio, K Kelly
1Department of Medicine, Medical College of Virginia, Richmond 23298.
Insights
Coronary angioplasty for diffuse disease showed high success rates (93-96%) but a notable 8% complication rate, primarily in patients with diffuse narrowing of entire vessels.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Diffuse coronary artery disease presents unique challenges for revascularization.
- Understanding the outcomes of angioplasty in different patterns of diffuse disease is crucial.
Purpose of the Study:
- To evaluate the efficacy and safety of percutaneous coronary angioplasty for diffusely diseased coronary arteries.
- To compare outcomes across different classifications of diffuse coronary disease.
Main Methods:
- Retrospective analysis of 98 patients undergoing angioplasty for diffuse coronary disease between 1983 and 1987.
- Classification of diffuse disease into three groups: diffuse narrowing, long lesions, and multiple lesions.
- Assessment of angiographic and clinical success, and complication rates.
Main Results:
- High rates of procedural success: 96% for lesions and 95% for vessels, with 93% angiographic success in diffusely diseased vessels.
- Overall clinical success was 93%, with an 8% complication rate (death, myocardial infarction, urgent bypass surgery).
- Complications were significantly higher in patients with diffuse narrowing of entire vessels (Group I, 17.5%) compared to long lesions (Group II, 2.5%) or multiple lesions (Group III, 0%).
Conclusions:
- Percutaneous coronary angioplasty is effective for treating diffuse coronary artery disease.
- Patients with diffuse narrowing of entire vessels face a substantially higher risk of complications following angioplasty.
Abstract:
From January 1983 through December 1987, 98 patients underwent angioplasty of at least one diffusely diseased coronary artery. Diffuse coronary disease was described as: group I, narrowing greater than or equal to 50% that involved the entire vessel (40 patients), group II, long lesions greater than or equal to 2 cm in length (39 patients), group III, three or more lesions in the same vessel (19 patients). There were 65 men and 33 women, with a mean age of 60 years; 64 patients (65%) had unstable angina, 23 patients (23%) were diabetic, 31 (32%) had prior myocardial infarctions, and 12 had prior bypass surgery. Multivessel disease was present in 89% of patients. Angioplasty of only the diffusely diseased vessel was performed in 41 patients, and additional vessels were dilated in 57 patients. Overall, of 396 lesions (four per patient) and 197 vessels (two per patient) attempted, success was achieved in 382 lesions (96%) and 187 vessels (95%); angiographic success was achieved in 112 of 120 diffusely diseased vessels (93%). Clinical success was achieved in 91 patients (93%). The overall complication rate (death, myocardial infarction, urgent bypass surgery) was 8% (8 of 98): six patients (6%) had myocardial infarction (one Q wave, five non-Q wave), one patient (1%) had urgent bypass surgery, and two patients (2%) died (one during bypass surgery). The majority of complications (7 of 8 or 87%), including the two deaths, occurred in group I patients, with a 17.5% rate, versus 2.5% in group II and 0% in group III, p less than 0.002.(ABSTRACT TRUNCATED AT 250 WORDS)