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Short- and long-term outcome after PTCA in patients with stable and unstable angina
H J Rupprecht1, R Brennecke, M Kottmeyer
1II. Medical Clinic, Johannes Gutenberg-University, Mainz, F.R.G.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) in unstable angina patients has higher acute complication risks. However, long-term outcomes show stable angina patients experience better quality of life post-PTCA.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common procedure for managing coronary artery disease.
- Differentiating outcomes between stable and unstable angina patients undergoing PTCA is crucial for treatment planning.
Purpose of the Study:
- To compare the acute and long-term outcomes of PTCA in patients with stable versus unstable angina.
- To assess the rates of major adverse cardiac events, mortality, and quality of life following PTCA in these patient groups.
Main Methods:
- A prospective study involving 406 patients with stable angina and 202 with unstable angina undergoing attempted PTCA.
- Follow-up data collected at acute, 12-month, and 36-month intervals to track cardiac events, mortality, and treatment status.
Main Results:
- Unstable angina patients had significantly higher rates of acute complications (6.4% vs 1.5%) and early cardiac events (10.4% vs 1.7%) within the first week post-PTCA.
- At 36 months, while long-term event rates showed no significant difference, cumulative myocardial infarction (3.7% vs 9.4%), mortality (3.0% vs 6.4%), and repeat PTCA (8.1% vs 19.3%) were lower in stable angina patients.
- Stable angina patients reported a better quality of life, with 74% asymptomatic compared to 60% of unstable patients, and a lower need for antianginal treatment (45% vs 28%).
Conclusions:
- PTCA in unstable angina is associated with a markedly enhanced risk of acute complications and early cardiac events.
- Despite similar long-term event rates, patients with stable angina achieve a better quality of life post-PTCA, characterized by fewer symptoms and reduced medical treatment needs.
Abstract:
Acute results and follow-up data over a period of 36 months after attempted PTCA in 406 patients with stable angina and 202 patients with unstable angina are reported. The rate of acute complications (death, myocardial infarction and bypass grafting (CABG) amounted to 1.5% in stable and 6.4% in unstable patients (P less than 0.005). Within the first week after PTCA a significantly lower percentage (1.7% vs 10.4%) of cardiac events (death, myocardial infarction, CABG and repeat PTCA) was observed in the stable group (P less than 0.001). During a 12-month follow-up period, another 16.3% of the patients in the stable group and 30.7% of unstable patients suffered a new cardiac event (P less than 0.001). The long-term follow-up of 36 months revealed no significant difference in the event rate between stable and unstable patients (5.4% in both groups). The cumulative rate of myocardial infarction within 3 years after PTCA was significantly lower (3.7% vs 9.4%) in the stable group (P less than 0.005). The cumulative mortality amounted to 3.0% in stable and 6.4% in unstable patients (P less than 0.05) and the incidence of repeated PTCA was 8.1% and 19.3% respectively (P less than 0.001). The crossover rate to CABG was 10.1% in stable and 17.8% in unstable patients (P less than 0.01). The total rate of any cardiac event thus amounted to 24.9% in stable and 53.0% in unstable patients (P less than 0.001) within a 3-year follow-up period. At the end of follow-up, 74% of the stable patients were asymptomatic, compared with 60% of unstable patients (P less than 0.01). 45% of the stable group patients and 28% of the unstable patients were not on antianginal treatment (P less than 0.01). We conclude that PTCA in unstable angina carries a markedly enhanced risk of acute complications and cardiac events in the early phase after PTCA. In the long run, patients with stable angina have a better quality of life with regard to medical treatment and angina symptoms.
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