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Long-term follow-up after percutaneous transluminal coronary angioplasty. The early Zurich experience
Insights
Long-term follow-up of percutaneous transluminal coronary angioplasty (PTCA) shows high survival and symptom relief, though restenosis and need for further procedures occur. Single-vessel disease patients fared better than those with multivessel disease.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common intervention for coronary artery disease.
- Long-term outcomes and restenosis rates after PTCA require continued investigation.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of percutaneous transluminal coronary angioplasty (PTCA).
- To assess cardiac survival, symptom recurrence, and need for reintervention in patients undergoing PTCA.
Main Methods:
- A cohort of 169 patients undergoing PTCA was followed for five to eight years.
- Data collected included procedural success, mortality, symptom status, stress test results, and need for repeat procedures.
Main Results:
- Technical success was achieved in 79% of patients, with 96% actuarial cardiac survival at six years.
- 67% of patients with successful PTCA were asymptomatic long-term; positive stress tests decreased from 97% to 10%.
- Restenosis occurred in 30% within six months, with some late recurrences; 79% event-free survival at six years.
Conclusions:
- PTCA offers significant long-term benefits in terms of survival and symptom relief, particularly for single-vessel disease.
- Most restenosis events occur early, but late recurrences are possible, necessitating ongoing monitoring.
- Patients with single-vessel disease demonstrate superior long-term outcomes compared to those with multivessel disease after PTCA.
Abstract:
The first 169 patients in whom percutaneous transluminal coronary angioplasty was performed have now been followed for five to eight years. The procedure was technically successful in 133 patients (79 percent). In the follow-up period, nine of the 133 patients died (five of cardiac disease), and actuarial cardiac survival was 96 percent at six years. All patients were symptomatic before angioplasty, but 67 percent of the 133 who had technically successful procedures were asymptomatic at the last follow-up evaluation. Exercise stress testing, positive in 97 percent before angioplasty, was positive at the last follow-up study in only 10 percent of the patients who had technically successful procedures. Stenosis recurred during the first six months in 30 percent of the patients, and six more recurrences were observed among the 41 patients who had follow-up angiograms at two to seven years. A second angioplasty was required in 27 patients, and coronary bypass surgery was subsequently needed in 19. Actuarial event-free survival (freedom from death, myocardial infarction, and coronary bypass surgery) was 79 percent at six years. Follow-up of patients with multivessel disease showed a higher mortality from cardiac causes and a lower rate of long-term success than occurred among patients with single-vessel disease. These long-term results indicate that most episodes of restenosis occurred within six months of angioplasty, but some late recurrences were seen. Patients with single-vessel disease had a better long-term outcome after angioplasty than those with multivessel disease.