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[Percutaneous revascularization with coronary angioplasty in patients with refractory angina]
R M Valdesuso Aguilar1, A Iñíguez Romo, M Córdoba Polo
1Unidad de Hemodinámica y Cardiología Intervencionista, Fundación Jiménez Díaz, Madrid.
Insights
Percutaneous Transluminal Coronary Angioplasty (PTCA) is a safe and effective treatment for refractory angina, offering high success rates and improved quality of life. Outcomes are similar whether or not patients have electrocardiographic changes at the time of the procedure.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Vascular Interventions
Background:
- Refractory angina, especially with ECG changes, carries high morbidity and mortality without urgent revascularization.
- Percutaneous Transluminal Coronary Angioplasty (PTCA) presents a viable therapeutic option for these high-risk patients.
Purpose of the Study:
- To compare the immediate and midterm outcomes of PTCA in high-risk patients with refractory angina.
- To assess the impact of electrocardiographic (ECG) changes on PTCA outcomes in this patient cohort.
Main Methods:
- Retrospective analysis of 48 patients (49 procedures) with refractory angina undergoing PTCA.
- Patients were divided into two groups: Group A (26 patients) with ECG changes and Group B (22 patients) without ECG changes.
- Outcomes including procedural success, adverse events, and mid-term follow-up were compared between groups.
Main Results:
- PTCA achieved a high initial success rate (96%) with no significant difference between groups.
- Mid-term follow-up (mean 13-17 months) showed a >90% survival rate and improved quality of life in most patients.
- Restenosis rates were comparable (47% in Group A vs. 54% in Group B).
Conclusions:
- PTCA is a safe and effective revascularization method for refractory angina.
- The procedure yields high initial success and good mid-term outcomes, including improved survival and quality of life.
- The presence or absence of ECG changes does not significantly alter PTCA outcomes in these patients.
Introduction And Objectives:
Refractory angina, specially when accompanied by electrocardiographic (ECGs) changes, has been associated with a high morbidity and mortality if urgent revascularization is not performed. Percutaneous Transluminal Coronary Angioplasty (PTCA) could be a useful therapeutic alternative in such cases. The aim of this study was to compare the immediate and midterm outcomes of a cohort of high risk patients with refractory angina with or without ECG changes revascularized by PTCA.
Methods:
Of 801 consecutive patients who underwent PTCA, we selected 48 patients (49 procedures, 61 lesions), with unstable angina in spite of treatment with nitroglycerin, calcium channel blockers, beta blockers, heparin and aspirin (refractory angina). Twenty-six patients (27 procedures, 37 lesions) had ECG changes (group A), and 22 patients (22 PTCAs, 24 lesions) did not have changes (group B).
Results:
Mean age of patients was 65 +/- 11 years. The most frequent ECG changes found in group A were T wave inversion (38%) and ST segment depression (34%). The left anterior descending coronary artery was the most frequent dilated vessel (41%). Some new devices (Stent, Rotablator, etc.) were used in 22% vs 25% of lesions in group A and B respectively. Successful dilatation was achieved in 59 (96%) of attempted lesion without statistical differences between group A and B. One patient in each group developed an acute myocardial infarction. Death occurred in 2 patients from group A (one of non-cardiovascular cause). Follow-up was obtained in 33 (94%) of the 35 patients (minimum follow-up > or = 6 months or less if a major event occurred). Mean follow-up time was 16.7 +/- 6 vs 13.4 +/- 6 months in group A and B. During this time, death occurred in 2 patients (6%) both from group B (one non-cardiac); in 9 (27%) patients a repeat PTCA was performed (26% of patients from group A and 28% from B); CABG was performed in 2 (6%) patients (both from group B), and an AMI occurred in 1 patient in each group. Angiographic follow-up was obtained in 73% of patients in group A vs 91% in group B. The restenosis rate was 47% in group A vs 54% in group B. At the end of the first year of follow-up, 93% of patients were alive and 9/10 patients successfully revascularized were asymptomatic or had less severe angina.
Conclusions:
At present, PTCA is a safe revascularization method in patients with refractory angina providing a high initial success (95% of cases) and a good mid-term outcome (one year): > 90% survival rate, with improvement in the quality of life in 9/10 patients successfully revascularized, regardless of the presence or absence of ECG changes at the time of PTCA.