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Immediate and follow-up results of coronary angioplasty--lessons for the future
N el Gaylani1, B F McAdam, U White
1Dept. of Cardiology, St. James's Hospital, Dublin.
Insights
Coronary angioplasty achieved 92% primary success in 129 patients. Follow-up showed 70% asymptomatic, with similar outcomes for single and multivessel disease, but poor results for chronic total occlusions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary angioplasty is a common procedure for treating coronary artery disease.
- Understanding the success rates and long-term outcomes is crucial for patient management.
Purpose of the Study:
- To evaluate the primary success and follow-up outcomes of coronary angioplasty in a cohort of patients.
- To compare the clinical outcomes between single-vessel and multivessel disease treated with angioplasty.
- To assess the efficacy of angioplasty for chronic total occlusions.
Main Methods:
- A retrospective analysis of 129 patients undergoing coronary angioplasty between 1989 and 1990.
- Data collected included patient demographics, clinical indications, coronary disease distribution, procedural success, complications, and follow-up clinical status and repeat angiography.
- Statistical analysis was performed to compare outcomes based on disease severity and treatment approach.
Main Results:
- Primary success rate was 92% with no deaths during the procedure. Complications included non-fatal myocardial infarction (3 patients) and peripheral vascular complications (2 patients).
- At a mean follow-up of 5.3 months, 70% of patients were asymptomatic. Single-vessel and multivessel disease showed similar clinical outcomes (69% vs. 70% asymptomatic).
- Angioplasty for chronic total occlusions had poor long-term results, with only 2 of 11 patients remaining asymptomatic without restenosis.
Conclusions:
- Coronary angioplasty demonstrates high primary success and favorable short-term outcomes, with target vessel angioplasty being effective for both single and multivessel disease.
- Angioplasty of chronic total occlusions yields suboptimal long-term results, indicating a need for alternative or adjunctive treatment strategies.
- The study supports the use of angioplasty as a primary treatment for coronary artery disease, while highlighting limitations for specific complex lesions.
Abstract:
In a series of 129 patients having coronary angioplasties in St. James's Hospital in 1989, the average age was 54.8 (30-77 years). There were 102 (79%) men and 27 (21%) females. Clinical indications were unstable angina 62, stable angina 26, post myocardial infarction 39 and asymptomatic ischaemia 2. The distribution of coronary disease was single vessel 62%, double vessel 28%, triple vessel 7% and previous coronary bypass surgery 3%. Only 10 patients had more than one vessel dilated. Primary success was achieved in 119 (92%), there were no deaths, 3 patients had abrupt closure of the vessel during angioplasty and sustained a nonfatal myocardial infarction, 1 patient required urgent bypass surgery and 2 patients had peripheral vascular complications requiring surgery. There were 6 failed angioplasties, 4 of which had chronic total occlusion. At a mean follow-up of 5.3 months, 85 patients had no symptoms, 34 had angina, 2 developed myocardial infarction and 1 died suddenly at 5 months. Repeat angiography was performed in 96 (79%) patients. At follow-up, no symptoms were present in 69% of those with single vessel disease and 70% of multivessel disease. Of those who had more than one vessel dilated in multivessel disease, 80% were asymptomatic (P = NS). There were 11 patients with initial total occlusion at presentation, 4 had failed angioplasties, 5 recurrent angina of which 4 reoccluded and 1 restenosed and only 2 were asymptomatic and without restenosis. Angioplasty was performed with primary success (92%) and follow up results (70% asymptomatic). Those with single or multivessel disease had similar clinical outcome, favouring the use of target vessel angioplasty. Long term results following angioplasty of chronic total occlusions were poor and suggests the need for additional treatment.