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[Long-term success of coronary angioplasty after repeated treatment]
F Schwarz1, H Störger, W Preusler
1Abteilung Kardiologie, Rotes-Kreuz-Krankenhaus Frankfurt/Main.
Insights
Repeating coronary angioplasty procedures for coronary heart disease improves long-term outcomes. Subsequent interventions show higher success rates and fewer complications than initial procedures, reducing the need for bypass surgery.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Context:
- Coronary heart disease (CHD) affects millions globally, necessitating effective revascularization strategies.
- Percutaneous coronary intervention (PCI), including angioplasty, is a primary treatment for CHD.
- Long-term outcomes after repeat angioplasty procedures for coronary stenosis are not fully elucidated.
Purpose:
- To evaluate the long-term efficacy and safety of second and third coronary angioplasty procedures.
- To compare the outcomes of repeat angioplasties with initial interventions for coronary stenosis.
- To assess the impact of repeat angioplasties on the need for subsequent surgical intervention.
Summary:
- Retrospective analysis of 1504 CHD patients undergoing repeat angioplasties revealed high initial success rates (95.5% for second, 100% for third).
- Repeat angioplasties demonstrated significantly better overall outcomes and reduced stenosis severity compared to initial procedures.
- Complications were infrequent after first angioplasty and absent after second/third procedures, with improved long-term outcomes in repeat interventions.
Impact:
- Repeat coronary angioplasty increases the likelihood of favorable long-term outcomes in patients with coronary heart disease.
- The findings suggest that repeat angioplasty is a safe and effective strategy, minimizing the need for coronary artery bypass grafting.
- This study supports the iterative use of angioplasty for managing coronary stenosis, offering a less invasive alternative to surgery.
Abstract:
To ascertain the long-term results after second and third angioplasties for coronary stenosis the coronary angiograms from 1504 consecutive patients with coronary heart disease (1211 men, 293 women, mean age 57 [27-82] years) were retrospectively surveyed. A good initial response (at least 20% reduction in stenosis) was achieved in 295 out of 306 second angioplasties (95.5%), and in all 36 third angioplasties. Viewed overall, these results are significantly better (P less than 0.005) than those achieved at the initial angioplasty (1386 out of 1504 patients; 92.2%). The reduction in the severity of the stenosis achieved at the second angioplasty (from 86 to 24%) and at the third angioplasty (from 86 to 26%) was the same as at the first angioplasty (from 88 to 28%). Serious complications after the first angioplasty were infrequent (death in 0.2%, emergency bypass in 0.4%, myocardial infarction in 0.5%), and no complications were noted after second and third angioplasties. A good long-term outcome (at least 20% reduction in stenosis at 3-4 months) was slightly more frequent after the second and third angioplasties (103 out of 170 [60.6%] and 14 out of 17 patients, respectively) than after the first intervention (532 out of 926 patients; 57.5%). In keeping with these results, the degree of stenosis found at follow-up angiography was significantly lower (first intervention 54.8%, second intervention 50.3%, third intervention 36.9%). There were only 57 patients (3.8%) who ultimately required operative treatment. These figures indicate that the probability of a good long-term outcome from coronary angioplasty increases each time the stretching operation is repeated. Only a very small proportion of patients will require bypass surgery.