[Effects of transluminal angioplasty on the prognosis after non-Q-wave infarction]

The long-term prognosis in non-Q-wave infarction (NQWI) has proven to be unfavorable due to frequent cardiac events. This study aimed at defining the impact of transluminal coronary angioplasty (TCA) on the prognosis, angina pectoris, ischemic ECG changes, and fitness for work in NQWI. TCA was performed on 114 patients at a mean of 3.8 months after NQWI with a success rate of 78% (success vs failure = 89 vs 25 patients). Clinical follow-up was obtained in 96% of patients at a mean of 49 months after successful TCA or 53 months after unsuccessful TCA, and 90% of patients had angiographic follow-up. Recurrent stenosis was recorded in 17 patients (21%): seven had a second TCA, one a bypass operation, and nine showed only lowgrade stenosis and were treated medically. Another seven patients had dilatation of a new stenosis. Seventy percent of the unsuccessfully dilated patients were subsequently treated with surgery. Differences in coronary morphology between both groups could be responsible for the success of the intervention, but not for the parameters analyzed. Reinfarction and death were found to occur more frequently during the follow-up period after unsuccessful angioplasty and exclusively in those who were treated medically. Most patients with unsuccessful TCA had a long-term benefit regarding improvement in symptoms, exercise-induced ischemia, and fitness for work. Coronary revascularization should consequently be indicated in patients with NQWI for prognostic reasons. The favorable long-term results observed regarding symptoms, myocardial ischemia, and fitness for work give evidence supporting coronary angioplasty as the primary revascularization procedure, if coronary anatomy permits.