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Transluminal coronary angioplasty in the treatment of silent ischemia
P Bergin1, R K Myler, R E Shaw
1San Francisco Heart Institute, Seton Medical Center, Daly City, California 94015.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) is effective for treating silent ischemia in asymptomatic patients. This intervention shows comparable success and restenosis rates to symptomatic populations, improving event-free survival.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Silent myocardial ischemia poses a risk for future cardiac events.
- Identifying effective primary therapies for asymptomatic patients is crucial.
Purpose of the Study:
- To evaluate the efficacy of percutaneous transluminal coronary angioplasty (PTCA) as a primary treatment for silent ischemia.
- To assess the long-term outcomes, including restenosis and major adverse cardiac events, following PTCA in this patient group.
Main Methods:
- Fifty-four asymptomatic patients with positive thallium exercise tests underwent coronary angiography and subsequent PTCA.
- Patients were followed for a mean of 35 months post-procedure to monitor for restenosis, new lesions, and clinical outcomes.
Main Results:
- PTCA was technically successful in 89% of patients, with low rates of emergency bypass graft surgery (3.6%) and myocardial infarction (1.8%).
- During follow-up, 19% experienced restenosis and 6% developed new lesions, necessitating repeat PTCA in some cases.
- At long-term follow-up, 85% of patients were successfully treated with one or more PTCA procedures, with no reported deaths.
Conclusions:
- PTCA is an efficacious primary therapy for silent ischemia, demonstrating outcomes comparable to those in symptomatic patients.
- Event-free survival appears improved compared to natural history data, suggesting PTCA benefits selected asymptomatic individuals.
- Risk-benefit analysis is recommended to identify subgroups most likely to benefit from primary angioplasty for silent ischemia.
Abstract:
Fifty-four asymptomatic patients with positive thallium exercise tests underwent coronary angiography followed by coronary angioplasty (PTCA), as the primary therapy for silent ischemia. The procedure was technically successful in 89% of these patients. Emergency bypass graft surgery was necessary in 2 (3.6%) and q-wave myocardial infarction occurred in 1 (1.8%) of these. All fifty-four patients have been followed for a mean of 35 months since angioplasty. Of the 48 patients with initially successful PTCA, 12 had either clinical restenosis (9/14 or 19%) or a new lesion (3/48 or 6%) during follow-up, which required a repeat PTCA. At the longest follow-up, 46 (85%) had been successfully treated with on or more PTCA procedures. Two patients (3.6%) had sustained late q-wave myocardial infarction and two additional patients reported angina pectoris. There were no deaths. Angioplasty as a primary therapy for silent ischemia appears efficacious, with success and restenosis rates comparable to those in the symptomatic population. Event-free survival is improved, compared with natural history data for patients with silent ischemia from other studies. Prudent risk/benefit analysis may help to define subgroups most likely to benefit from this intervention.