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Outcome > or = 10 years after successful percutaneous transluminal coronary angioplasty
D Hasdai1, M R Bell, D E Grill
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
Insights
Long-term outcomes after percutaneous transluminal coronary angioplasty show that extent of coronary disease, diabetes, hypertension, male gender, and prior myocardial infarction predict major adverse events. These factors help identify patients with a worse prognosis post-procedure.
Area of Science:
- Cardiology
- Interventional Cardiology
- Long-term Patient Outcomes
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common procedure for coronary artery disease.
- Long-term prognosis after successful PTCA requires detailed analysis of various clinical and angiographic factors.
Purpose of the Study:
- To prospectively evaluate major adverse events (MAEs) in patients post-PTCA over 10-16 years.
- To identify predictors of adverse outcomes, including gender, disease extent, left ventricular function, and age.
Main Methods:
- Prospective follow-up of 611 patients after successful PTCA.
- Analysis of major adverse events: death, Q-wave myocardial infarction, and coronary bypass surgery.
- Multivariate analysis to determine independent predictors of MAEs.
Main Results:
- Incidence of death, Q-wave myocardial infarction, and coronary bypass surgery were 23.1%, 3.9%, and 32.7%, respectively.
- Multivessel disease, left ventricular dysfunction, and older age were associated with higher mortality.
- Extent of coronary disease, diabetes mellitus, hypertension, male gender, and prior myocardial infarction independently predicted MAEs.
Conclusions:
- Long-term prognosis after PTCA can be predicted using clinical and angiographic parameters.
- Identifying high-risk patients allows for tailored management strategies.
- Extent of coronary disease is a critical factor influencing long-term adverse events post-PTCA.
Abstract:
Patients (n = 611) after successful percutaneous transluminal coronary angioplasty were prospectively followed over 10 to 16 years for major adverse events. The effect of gender, extent of coronary artery disease, left ventricular dysfunction, and age on occurrence of adverse events were analyzed in detail. The incidence of death, Q-wave myocardial infarction, and coronary bypass surgery was 23.1%, 3.9%, and 32.7%, respectively. Men and women had similar mortality (p = 0.13) and Q-wave myocardial infarction (p = 0.57), but men had more coronary bypass surgery (p = 0.06). Patients with multivessel disease had higher mortality (p < 0.0001), and patients with 3-vessel disease had a higher incidence of Q-wave myocardial infarction (p = 0.04) and coronary bypass surgery (p < 0.001). Left ventricular dysfunction was associated with higher mortality (p < 0.0001) and coronary bypass surgery (p = 0.045), but not Q-wave myocardial infarction (p = 0.99). Mortality was higher in elderly patients (p < 0.0001), but the incidence of Q-wave myocardial infarction was similar (p = 0.64). Older patients underwent coronary bypass surgery less often (p = 0.004). By multivariate analysis, only the extent of coronary disease (relative risk [RR] 1.71, confidence interval [CI] 1.34 to 2.19; p = 0.0001), diabetes mellitus (RR 1.82, CI 1.28 to 2.59; p = 0.001), hypertension (RR 1.30, CI 1.08 to 1.96, p = 0.009), male gender (RR 1.30, CI 0.99 to 1.71, p = 0.058), and prior myocardial infarction (RR 1.44, CI 1.14 to 1.81, p = 0.002) independently influenced the incidence of major adverse events. We conclude that it is possible to identify patients with worse long-term prognosis after percutaneous transluminal coronary angioplasty based on clinical and angiographic parameters.