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[5 years' experience in complex percutaneous transluminal coronary angioplasty]
1Departamento de Hemodinamia, Patronato de Enfermedades Cardiovasculares y Cáncer AC, Hospital CIMA, Chihuahua.
Insights
Angioplasty in high-risk patients showed increased mortality in those over 70 and with low ejection fraction. Lesion complexity significantly impacted success rates, especially in unstable angina and acute myocardial infarction cases.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a key revascularization strategy.
- Assessing PTCA outcomes in high-risk patient cohorts is crucial for clinical decision-making.
Purpose of the Study:
- To analyze the results of angioplasty in 117 patients from 1990-1995.
- To identify factors influencing outcomes in high-risk patients undergoing PTCA.
Main Methods:
- Retrospective analysis of 117 patients undergoing angioplasty.
- Inclusion criteria for high-risk patients: age >70, ejection fraction <40%, specific coronary artery occlusions, multivessel disease (B/C lesions), unstable angina (UA), and acute myocardial infarction (AMI).
Main Results:
- Mortality was higher in patients >70 years (14%) vs. <70 years (7%) and in those with ejection fraction <40% (33%) vs. >40% (4.3%).
- Angioplasty success varied by lesion type (90.3% for B, 50% for C).
- In UA, 65% had anterior descending coronary artery compromise, with 10% mortality. Primary PTCA success in AMI was 71.4%.
Conclusions:
- High-risk factors like advanced age and reduced ejection fraction are associated with increased angioplasty mortality.
- Lesion characteristics and patient presentation (UA/AMI) significantly influence angioplasty success and outcomes.
Abstract:
We analysed the results of angioplasty done in 117 patients from 1990 to 1995, considering high risk: the following: age over 70 years, ejection fraction lower than 40%, obstruction of anterior descending coronary artery (ADCA) with 100% occlusion of the right coronary artery (RCA) or a dominant circumflex artery (CXA), multivessel lesions B and C, and unstable ischemic syndromes: unstable angina (UA) and acute myocardial infarction (AMI). The mortality in patients older than 70 years (36 patients) was 14% against 7% in those under 70 years (p < 0.05). Mortality in EF (21 under 40% was 33%, higher than patients with EF over 40%, 4.3% (p < 0.01). Patients with obstruction of ADCA and 100% occlusion of RCA or dominant CxA (19), 3(14%) needed coronary revascularization and 4 died from cardiac reasons. In multivessel disease (14) the rate of success depends more on the type of the lesion than on the number. In lesions B and C (54) the dilatation success was 90.3% in B and 50% in C. In UA (29) the ADCA was found compromised in 65% (p < 0.05), early reocclusion was in 4 (13%) and late in 1 (3%), all developed AMI, mortality was 3 (10%). In AMI (21) treated with primary PTCA success was achieved in 15 patients (71.4%).