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Long-term outcome of unsuccessful percutaneous transluminal coronary angioplasty

M Tuzcu1, C Simpfendorfer, K Dorosti

  • 1Department of Cardiology, Cleveland Clinic Foundation, OH 44195.

American Heart Journal
|April 1, 1990
PubMed

Insights

Coronary artery bypass grafting surgery after failed percutaneous transluminal coronary angioplasty significantly improves long-term cardiac survival and event-free survival compared to medical treatment alone.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Percutaneous transluminal coronary angioplasty (PTCA) is a common procedure for coronary artery disease.
  • Unsuccessful PTCA necessitates alternative treatment strategies.
  • Long-term outcomes after failed PTCA require further investigation.

Purpose of the Study:

  • To evaluate the long-term outcomes of patients following unsuccessful percutaneous transluminal coronary angioplasty.
  • To compare the effectiveness of different management strategies: emergency bypass surgery, elective bypass surgery, and medical treatment.

Main Methods:

  • Retrospective analysis of 198 patients with failed PTCA.
  • Categorization into emergency bypass surgery (49%), elective bypass surgery (17%), and medical treatment (34%).
  • Assessment of in-hospital mortality, myocardial infarction rates, and long-term actuarial cardiac and event-free survival.

Main Results:

  • In-hospital mortality was 4%; myocardial infarction occurred in 36% of patients.
  • Four-year actuarial cardiac survival: 97% (emergency bypass), 100% (elective bypass), 86% (medical).
  • Four-year event-free survival: 90% (emergency bypass), 85% (elective bypass), 65% (medical).

Conclusions:

  • Emergency or elective coronary artery bypass grafting surgery after failed PTCA predicts better 4-year outcomes.
  • Normal or mildly impaired left ventricular function and male sex are also associated with improved outcomes.
  • Surgical revascularization is a superior strategy to medical management for selected patients post-failed PTCA.

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