Use of percutaneous transluminal coronary angioplasty: results of a current survey

To evaluate the current use of percutaneous transluminal coronary angioplasty (PTCA) in the treatment of coronary artery disease, 50 operators experienced in angioplasty (mean experience 949 +/- 706 cases) were surveyed. Although the use of angioplasty is still skewed toward less extensive disease (80% of 1-, 64% of 2- and 39% of 3-vessel disease), it is now estimated that 39 +/- 16% of patients undergoing diagnostic angiography are ultimately referred for PTCA, whereas only 28 +/- 13% are referred to bypass surgery. PTCA thus accounts for 58% of revascularization. Although approximately half of current PTCA patients are clinical candidates for bypass surgery, much of the growth of angioplasty has consisted of treating patients who are either too high a risk for bypass, or who have symptoms with medical therapy that are too mild to warrant surgery. Whereas elective procedures for stable angina (60 +/- 18%) are still the predominant indication for PTCA, a substantial fraction of procedures are performed for unstable angina (27 +/- 10%) or for acute myocardial infarction (13 +/- 15%). Despite a 91% current success rate, 9% of cases are unsuccessful, including 3% in which emergency bypass surgery is required. The most common reasons for unsuccessful procedures are failure to cross the lesion with a wire or balloon (52%), failure to dilate the lesion (4%), and abrupt closure of the dilated segment (44%) due predominantly to extensive local dissection. These data, based on a pooled experience of some 46,000 PTCA procedures, offer a unique glimpse into the current expanded application of this technique.