Related Experiment Videos
Efficacy of percutaneous transluminal coronary angioplasty compared with single-vessel bypass
Insights
Percutaneous transluminal coronary angioplasty offers symptom relief similar to bypass surgery but may increase risks of heart attack and symptom recurrence. Coronary artery bypass surgery showed no such complications in this study.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) use is increasing for coronary artery disease.
- PTCA offers symptom relief comparable to coronary artery bypass (CAB).
- PTCA is suggested to have lower morbidity, mortality, and shorter hospital stays than CAB.
Purpose of the Study:
- To evaluate and compare the outcomes of PTCA versus single-vessel CAB.
- To assess complication rates and symptom recurrence for both procedures.
Main Methods:
- Retrospective review of 198 PTCA procedures (1982-1983).
- Comparison with 143 single-vessel CAB procedures during the same period.
- Analysis of procedural success, emergency/elective bypass, perioperative myocardial infarction, mortality, and symptom recurrence.
Main Results:
- PTCA success rate was 71.7% (142/198).
- Emergency CAB after failed PTCA had a 38.1% perioperative myocardial infarction rate.
- Initially successful PTCA had a 21.8% early symptom recurrence rate.
- Single-vessel CAB (internal mammary artery or saphenous vein) had no perioperative myocardial infarctions or deaths, and no symptom recurrence.
Conclusions:
- PTCA is a viable alternative to CAB for localized, symptomatic coronary lesions.
- PTCA is associated with a higher incidence of acute myocardial infarction and early symptom recurrence compared to single-vessel CAB.
- Single-vessel CAB demonstrated superior long-term outcomes regarding symptom recurrence and perioperative complications in this cohort.
Abstract:
The use of percutaneous transluminal coronary angioplasty has been increasing rapidly. When the procedure is successful, the clinical relief of symptoms is similar to that achieved with direct coronary artery bypass. It has been suggested that the angioplasty procedure, however, can accomplish these results with potentially less morbidity and mortality, along with a shorter hospital stay. In order to evaluate the results of percutaneous transluminal coronary angioplasty with single-vessel coronary artery bypass, we performed a retrospective review. From January, 1982, to December, 1983, a total of 198 angioplasty procedures were performed. They were successful in 142 patients (71.7%). Emergency bypass was performed in 21 (10.6%) of the 56 patients who had undergone unsuccessful angioplasty procedures. Perioperative myocardial infarction occurred in eight of these patients (38.1%). There were no operative deaths, but there was one death after angioplasty. Elective bypass was performed in 28 of the patients who had angioplasty procedures, with no perioperative myocardial infarctions or operative deaths. Recurrent symptoms developed in 31 (21.8%) of the 142 patients who had undergone initially successful angioplasty. From 1982 to 1983, single-vessel bypass was performed in 143 patients. The internal mammary artery was utilized in 102 patients and the autogenous saphenous vein in 41 patients. There were no perioperative myocardial infarctions or deaths. No patients developed recurrent symptoms during the study interval. Percutaneous transluminal coronary angioplasty is an acceptable alternative to coronary artery bypass in patients with localized lesions that are sufficiently serious to cause symptoms and warrant surgical bypass. However, the angioplasty procedure, when compared to single-vessel coronary artery bypass, may result in an increased incidence of acute myocardial infarction and in a significantly (p less than 0.001) increased incidence of early recurrence of symptoms.