Related Experiment Videos
Early results after percutaneous transluminal coronary angioplasty in 400 patients
Insights
Percutaneous transluminal coronary angioplasty (PTCA) is highly effective for single-vessel disease, offering symptom relief and minimal complications. For multivessel disease, PTCA provides significant symptom improvement, especially when all lesions are addressed, with low mortality rates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common treatment for coronary artery disease.
- Understanding PTCA outcomes in single versus multivessel disease is crucial for patient management.
- Sequential stenoses within the same vessel were addressed in all patient groups.
Purpose of the Study:
- To evaluate the efficacy and safety of PTCA in patients with single-vessel disease (SVD) and multivessel disease (MVD).
- To compare outcomes between different PTCA strategies, including single-vessel dilatation and multivessel dilatation.
- To assess the success rates, complication rates, and long-term symptom relief following PTCA.
Main Methods:
- A consecutive series of 400 patients undergoing PTCA were analyzed.
- Patients were categorized into single-vessel disease (n=212), multivessel disease with single vessel dilated (n=142), and multivessel dilatation (n=46).
- Outcomes included primary success rates, urgent surgery requirements, mortality, and symptom improvement via exercise testing.
Main Results:
- No mortality was observed in the single-vessel disease group, with success rates of 83-90%.
- Multivessel disease patients had lower primary success (74%) and higher complications (2.8% mortality).
- Multivessel dilatation in MVD patients yielded 76% primary success (91% in the last year), with 2% mortality and 7% requiring urgent surgery. Successful dilatation of stenosed vein grafts (86%) and re-opening of occluded vessels (53%) occurred without deaths or urgent surgery.
- Significant symptom improvement (94% in SVD, 65% in incomplete revascularization) and normal exercise tests (80% at one year) were noted across groups.
Conclusions:
- PTCA is the preferred treatment for single-vessel disease, achieving high success and symptom relief with low complication rates.
- PTCA offers significant symptomatic benefits for selected multivessel disease patients, with comparable results to cardiac surgery in some cases.
- The procedure demonstrates effectiveness in treating stenosed vein grafts and occluded vessels, with a favorable safety profile.
Abstract:
In a consecutive series of 400 patients treated by percutaneous transluminal coronary angioplasty 212 had single vessel disease, 142 had multivessel disease with only one vessel dilated, and 46 had multivessel dilatation. In addition sequential stenoses were dilated in the same vessel in all groups. There was no mortality among patients with single vessel disease. Success rates varied from 83% to 90% according to the artery in which angioplasty was attempted. Urgent surgery was required by 3.8%. Primary success was lower (74%) in the presence of multivessel disease and complications were more frequent, with four deaths (2.8%). In 46 patients with multivessel disease in whom all important lesions were dilated during the same procedure the overall primary success rate was 76% and within the last year of the study it was 91%. One (2%) patient died and three (7%) required urgent surgery. Twelve (86%) out of 14 stenosed vein grafts were successfully dilated and eight (53%) chronically occluded vessels were re-opened; in both groups there were no deaths, no infarctions, and no need for urgent surgery. In all groups symptoms improved greatly and predischarge exercise tests showed that there was no reversible ischaemia in 94% of patients with single vessel disease or in 65% of patients with incomplete revascularisation. Six months after the procedure 95% of the patients had improved symptomatically and 80% had normal exercise tests after one year. Percutaneous transluminal coronary angioplasty is the method of choice in single vessel disease and its use also results in a high proportion of other patients becoming symptom free. Complication rates are low and for selected patients results that are equivalent to those of cardiac surgery are obtained.