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Long-term outcome of patients after percutaneous transluminal coronary angioplasty
D P Faxon1, N Ruocco, A K Jacobs
1Evans Memorial Department of Clinical Research, Boston University Medical Center, Massachusetts.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) effectively relieves coronary artery disease symptoms. Long-term outcomes show sustained improvement, though multivessel disease patients experience higher mortality rates compared to single-vessel disease.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a widely adopted intervention for coronary artery disease (CAD).
- Long-term outcomes of PTCA, especially in multivessel disease, require further definition.
- Early studies focused on single-vessel disease, showing favorable short-term results.
Purpose of the Study:
- To evaluate the long-term efficacy and outcomes of PTCA in patients with coronary artery disease.
- To compare outcomes between single-vessel and multivessel disease treated with PTCA.
- To identify factors influencing symptomatic improvement and need for revascularization after PTCA.
Main Methods:
- Review of studies on patients undergoing PTCA for single-vessel and multivessel coronary artery disease.
- Analysis of mortality, nonfatal myocardial infarction (MI), and clinical improvement rates over time.
- Assessment of the impact of revascularization degree on patient outcomes.
Main Results:
- Early PTCA studies (single-vessel disease) reported low annual mortality (1%) and MI (1-3%), with 85-90% improvement at 5 years.
- Recent studies (multivessel disease) show higher annual mortality (2-4%) and similar MI rates (2-3%), with 70-80% symptomatic improvement.
- Optimal outcomes are associated with >20% lesion reduction and no significant residual proximal lesions.
Conclusions:
- PTCA provides significant symptomatic relief for coronary artery disease patients.
- Long-term outcomes vary between single-vessel and multivessel disease, with higher risks in the latter.
- Further trials are needed to compare PTCA directly with coronary artery bypass surgery for multivessel disease.
Abstract:
The efficacy of percutaneous transluminal coronary angioplasty (PTCA) in relieving symptoms of coronary artery disease is well established, and the technique has become widely used in patients with multivessel as well as single-vessel disease. The technique has only recently been widely applied, and long-term outcome is, therefore, not well defined. Studies of patients who underwent the procedure early in its development were primarily of patients with single-vessel disease. These studies demonstrated low mortality (1%/yr) and nonfatal myocardial infarction (MI) rates (1-3%/yr), with a majority of patients (85-90%) clinically improved after 5 years. More recent studies of patients with multivessel disease demonstrate higher mortality (2-4%/yr) and a similar incidence of nonfatal MI (2-3%/yr), with improvement in symptoms in the majority (70-80%). The degree of revascularization can be an important factor in symptomatic improvement as well as in the need for subsequent revascularization. A favorable outcome is most likely when all lesions attempted with PTCA are reduced by at least 20% and no significant residual lesions remain in any proximal vessels. The efficacy of PTCA as compared with bypass surgery in patients with multivessel disease is uncertain. The results of several large ongoing and planned clinical trials should provide the information necessary to more fully understand the use of angioplasty in this setting. Although no study has directly compared PTCA with coronary artery bypass surgery, nonrandomized comparisons indicate similar long-term outcomes.(ABSTRACT TRUNCATED AT 250 WORDS)