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[Elective coronary angioplasty in total absence of heart surgery]
F Ribichini1, G Steffenino, A Dellavalle
1Laboratorio di Emodinamica, Divisione di Cardiologia, Ospedale Santa Croce, Cuneo.
Insights
Elective coronary angioplasty without surgical backup is safe for selected patients. This study found a high success rate with minimal complications, indicating acceptable risk in carefully chosen individuals.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- 100 elective coronary angioplasty procedures were performed in 95 patients without surgical stand-by.
- All patients presented with angina and/or inducible ischemia.
Purpose of the Study:
- To evaluate the safety and efficacy of elective coronary angioplasty in the absence of surgical coverage.
- To determine the risk associated with performing this procedure in selected patients.
Main Methods:
- Patient selection was based on clinical and angiographic assessments of potential vessel occlusion consequences and bail-out technique applicability.
- Informed consent was obtained from all patients and physicians, acknowledging the lack of surgical coverage.
Main Results:
- Primary success was achieved in 92% of cases, with Palmaz-Schatz stent implantation in 5 instances.
- 6 procedures were unsuccessful but without complications.
- No patient died or required cardiac surgery within one month post-discharge; two experienced non-Q-wave myocardial infarctions.
Conclusions:
- Elective coronary angioplasty can be safely performed in carefully selected patients without surgical stand-by.
- The procedure demonstrated an acceptable risk profile in this initial experience.
- This approach may be a viable option for specific patient populations.
Background:
One-hundred consecutive procedures of elective coronary angioplasty were attempted in 95 patients, in the absence of any surgical stand-by. All patients had angina and/or signs of inducible ischemia.
Methods:
All patients and attending physicians were informed that no surgical coverage was available, and gave their consent. The choice was made on the basis of the estimate, on clinical and angiographic grounds, of the consequences of vessel occlusion, of the possible help offered by percutaneous bail-out techniques, and of the applicability of surgical stand-by.
Results:
A primary success was achieved in 92 cases: in 5 cases a Palmaz-Schatz stent was implanted. In 6 cases the procedure was unsuccessful, with no complications. Two patients sustained a myocardial infarction without new Q-waves. No patient died, nor underwent cardiac surgery within 1 month of discharge.
Conclusions:
Our initial experience suggests that, in the absence of surgical stand-by, elective coronary angioplasty can be performed in selected patients at an acceptable risk.