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Usefulness of coronary angioplasty in asymptomatic patients
H V Anderson1, J D Talley, A J Black
1Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Insights
Coronary angioplasty in asymptomatic patients with silent myocardial ischemia showed high success rates. This procedure led to low cardiac event rates and no deaths during long-term follow-up.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Coronary angioplasty is typically performed in patients with symptomatic myocardial ischemia.
- The efficacy and safety of angioplasty in asymptomatic individuals with silent ischemia are less understood.
Purpose of the Study:
- To evaluate the outcomes of elective coronary angioplasty in asymptomatic patients with documented silent myocardial ischemia.
- To assess the short-term and long-term safety and efficacy of this intervention.
Main Methods:
- Retrospective analysis of 114 asymptomatic patients who underwent elective coronary angioplasty between June 1980 and December 1987.
- Documentation of exercise-induced silent myocardial ischemia prior to angioplasty.
- Follow-up assessment of cardiac events, including death, myocardial infarction, and need for revascularization.
Main Results:
- 1.7% of 6,545 patients undergoing angioplasty were asymptomatic but had silent ischemia.
- Successful angioplasty was achieved in 87% of these patients.
- Over a mean follow-up of 43 months, there were no deaths, 95% freedom from myocardial infarction, and 61% freedom from major adverse cardiac events (death, MI, or repeat revascularization).
Conclusions:
- Elective coronary angioplasty is a safe and effective treatment for carefully selected asymptomatic patients with silent myocardial ischemia.
- The procedure offers good long-term event-free survival, including freedom from death and myocardial infarction.
Abstract:
Of 6,545 patients who had elective coronary angioplasty procedures performed over a 7.5-year period from June 1980 through December 1987, 114 (1.7%) never had symptoms of myocardial ischemia. Exercise-induced silent myocardial ischemia was documented before angioplasty in 94% of these asymptomatic patients. Angioplasty was successful in 87%, whereas emergency coronary artery bypass grafting was required in 4%, and a further 2% had myocardial infarctions after the procedures. The remaining 7% had unsuccessful angioplasty procedures but experienced no in-hospital cardiac events. The follow-up period after hospital discharge averaged 43 +/- 20 months (range 5 to 93). There were no deaths. In the group of 99 patients with initially successful angioplasty procedures the follow-up interval ranged from 5 to 92 months. During that period, 7 patients underwent coronary bypass surgery, 4 patients had myocardial infarction and 30 patients had repeat angioplasty procedures for restenosis. The cumulative probability of event-free survival over 5 years for the group with successful angioplasty was: 100% freedom from death, 95% freedom from myocardial infarction, 87% freedom from myocardial infarction or coronary bypass surgery and 61% freedom from myocardial infarction, coronary bypass surgery or repeat angioplasty. Thus, coronary angioplasty performed in 114 asymptomatic patients, most with exercise-induced silent myocardial ischemia, achieved very good primary success and was accompanied by low cardiac event rates and no deaths over several years of patient follow-up.