Related Experiment Videos
Changes in patient treatment after abrupt closure complicating percutaneous transluminal coronary angioplasty: a
N Danchin1, V Daclin, Y Juillière
1Services de Cardiologie A et B, CHU de Nancy-Brabois, Vandoeuvre-lès-Nancy, France.
Insights
The incidence of acute closure after coronary angioplasty significantly decreased over time, with improved patient outcomes and a shift towards repeat angioplasty over emergency bypass surgery.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Technology
Background:
- Acute closure is a serious complication of coronary angioplasty.
- Management strategies and outcomes for acute closure have evolved with advancements in interventional cardiology.
Purpose of the Study:
- To compare the incidence and management of acute closure complicating coronary angioplasty across different historical patient cohorts.
- To evaluate trends in treatment strategies and patient outcomes over time.
Main Methods:
- Retrospective analysis of three patient groups undergoing coronary angioplasty between 1980-1986, 1990-1992, and 1993.
- Comparison of acute closure incidence, management interventions (bypass surgery, repeat angioplasty), procedural techniques (stenting, prolonged inflations), and in-hospital outcomes (death, myocardial infarction, event-free survival).
Main Results:
- The incidence of acute closure decreased significantly from 17% in the early years to 6% in later periods (p < 0.001).
- Management shifted from emergency coronary bypass surgery (36% to 9%) towards repeat angioplasty (48% to 88%) (p < 0.01 and p < 0.001, respectively).
- Use of stenting and prolonged inflations increased, while in-hospital death rates remained stable (6-12%) and acute myocardial infarction decreased (64% to 27%). Patient event-free survival improved significantly (26% to 68%).
Conclusions:
- Coronary angioplasty techniques and management have evolved, leading to a substantial reduction in acute closure incidence.
- The adoption of stenting and repeat angioplasty has improved patient outcomes and reduced the need for emergency bypass surgery.
- Continued advancements in interventional cardiology have enhanced the safety and efficacy of coronary angioplasty procedures.
Abstract:
This study compares the incidence and management of acute closure complicating coronary angioplasty in three historic populations of patients having undergone the procedure at the same center: group 1 (n = 146 of 881) ("early years" of angioplasty, 1980 to 1986), group 2 (n = 113 of 1781) (bailout stenting learning curve, 1990 to 1992), and group 3 (n = 34 of 525) (1993). The incidence of acute closure decreased from group 1 (146 [17%] of 881) to groups 2 and 3 (147 [6%] of 2306); (p < 0.001). Management of the occlusion changed over the years, with less emergency coronary bypass surgery ([36%] 52 of 146, 15 [13%] 113, and 3 [9%] of 34), respectively, p < 0.01) and more repeat angioplasty (70 [48%] of 146; 87 [78%], of 113, and 30 [88%] of 34, p < 0.001). The use of prolonged inflations (> 10 minutes) and stenting increased from group 2 (15 [13%] of 113 and 16 [14%] of 113, respectively) to group 3 (12 [35%] of 34, and 10 [30%] of 34, respectively). In-hospital death occurred in 18 (12%) of 146, 7 (6%) of 113), and (2 (6%) of 34) patients in the three groups. Acute myocardial infarction decreased from 64% to 46% and 27%, respectively (p < 0.01). Overall, the number of patients free of events at hospital discharge increased from 38 (26%) of 146 to 53 (47%) of 113 (p < 0.001) and to 23 (68%) of 34 (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)