No abstract

To determine risk factors for restenosis, we studied 998 patients who underwent elective coronary angioplasty (PTCA) No. 4, 710-717, 1986. PERCUTANEOUS transluminal coronary angioplasty (PTCA) has become an attractive therapeutic option in selected patients with coronary artery disease. Despite the undoubted initial and long-term efficacy of PTCA, the problem of restenosis remains. Reported rates of restenosis in various subsets of patients range from 17% to 47%,t1-but there is limited information on factors that predispose to recurrence of lesions. Most reported studies include relatively few patients,' I-' and data from the National Heart, Lung, and Blood Institute (NHLBI) PTCA Registry,2 apart from representing early experience with the procedure, included results from many centers in which PTCA procedures and angiographic interpretations were not optimally standardized. This study was undertaken to determine

No abstract

To assess whether gender influenced the outcome of percutaneous transluminal coronary angioplasty (PTCA), we analyzed data from the NHLBI major complications (death, myocardial infarction, emergency surgery) was not different (9.8% vs 9.3%). Women had a higher incidence of coronary dissection (p < .05) and higher in-hospital mortality (1 .8% vs 0.7%; p < .01). PTCA-related mortality was nearly six times higher in women (1.7% vs 0.3%; p < .001) and mortality with emergency surgery was more than five time higher (17.4% vs 3.2%; p < .001). Multivariate analysis indicated that female gender was an independent predictor for lower success (p < .05) and early mortality (p < .05) and was the only baseline predictor for PTCA-related mortality. Late results in 2272 patients from centers with virtually complete follow-up of 1 year or longer (mean 18 months) showed comparable or better results in women than men. Men had higher rates of angiographic restenosis (36% vs 22%; p < .01), repeat PTCA (18% vs 10%; p < .01), additional revascularization (27% vs 18%; p < .01), and cumulative mortality (2.2% vs 0.3%; p < .05), and frequency of symptomatic improvement similar to that in women. These NHLBI Registry data indicate that PTCA in women was associated with less favorable short-term outcome, lower initial success rate,and higher mortality rate than in men. However, longer-term results after PTCA were comparable or better in women, with similar symptomatic improvement. lower rates of restenosis, and improved survival compared with men.Circulation 71, No. 1, 90-97, 1985. CORONARY artery bypass surgery is an effective means of myocardial revascularization that provides symptomatic improvement in most patients. Factors influencing outcome with coronary bypass surgery have been identified, and a number of reports indicate that less favorable results are achieved in women than in men.`These differences in results include higher operative mortality, lower graft patency rates, and less symptomatic improvement in women. Percutaneous transluminal coronary angioplasty (PTCA), a newer, nonsurgical technique, is also a safe and effective

The purpose of this study was to develop and validate a method for quantifying the uptake, redistribution, and washout of thallium-201 (201T1) obtained with rotational tomography. This method generates maximum count circumferential profiles of the short-axis slices of the left ventricle, translates them into polar coordinate profiles, and displays them as a bullseye plot, which consists of a series of concentric circles with the apex at the center and the base at the periphery. Normal limits were established for the distribution of°0T1 in 36 patients with a low (<5%) probability of coronary artery disease (CAD). Forty-five patients who had undergone coronary angiography were used as a pilot group to define criteria for the identification and localization of perfusion defects. The best agreement with the results of angiography was found when abnormal regions of the bullseye were defined as contiguous defects over 2.5 SDs below normal. These criteria were applied prospectively to 210 points (179 points with >50% diameter stenosis and 31 with <50%). Visual, quantitative, and combined visual and quantitative analysis were compared for overall detection of disease and for detection of individual vessel involvement. The overall sensitivity for detection of disease by these methods was 97%, 95%, and 95%, respectively. The specificities were 68%, 74%, and 71% respectively. The sensitivity for detection of individual vessel involvement with the bullseye alone was 78% for the left anterior descending artery (LAD), 89% for the right coronary artery (RCA), and 65% for the left circumflex (LCx). For visual analysis, the results were 70%, 88%, and 50%, respectively, while the use of visual and quantitative analysis combined identified 75% of LAD, 87% of RCA, and 55%

We prospectively recorded all in-hospital complications of the first 3500 consecutive patients to undergo elective coronary angioplasty (PTCA) at Emory University Hospitals from July 14, 1980, to August 28, 1984, by

The first 169 patients in whom percutaneous transluminal coronary angioplasty was performed have now been followed for five to eight years. The procedure was technically successful in 133 patients (79 percent). In the follow-up period, nine of the 133 patients died (five of cardiac disease), and actuarial cardiac survival was 96 percent at six years. All patients were symptomatic before angioplasty, but 67 percent of the 133 who had technically successful procedures were asymptomatic at the last follow-up evaluation. Exercise stress testing, positive in 97 percent before angioplasty, was positive at the last follow-up study in only 10 percent of the patients who had technically successful procedures. Stenosis recurred during the first six months in 30 percent of the patients, and six more recurrences were observed among the 41 patients who had follow-up angiograms at two to seven years. A second angioplasty was required in 27 patients, and coronary bypass surgery was subsequently needed in 19. Actuarial event-free survival (freedom from death, myocardial infarction, and coronary bypass surgery) was 79 percent at six years. Follow-up of patients with multivessel disease showed a higher mortality from cardiac causes and a lower rate of long-term success than occurred among patients with single-vessel disease. These long-term results indicate that most episodes of restenosis occurred within six months of angioplasty, but some late recurrences were seen. Patients with single-vessel disease had a better long-term outcome after angioplasty than those with multivessel disease.

Restenosis after percutaneous transluminal coronary angioplasty (PTCA) is strongly associated with incomplete initial dilatation. To determine if oversized PTCA balloons would reduce the restenosis rate without increasing the risk of arterial dissection and acute complications, we prospectively randomized 336 patients to receive either smaller or larger balloons. Thirty-four percent of patients had multivessel disease and 18% had multisite dilatation. One hundred sixty-nine patients were randomized to PTCA with a larger balloon and 167 to PTCA with a smaller balloon. Balloon:artery diameter ratios were 1.13+±-0.14 in the larger group and 0.93+± 0.12 in the smaller group (p<0.001). The trial was halted as clinically important differences in acute complications emerged. Emergency bypass graft surgery, usually for the treatment of arterial dissection, was required in 7.1% of patients in the larger balloon group and 3.6% of patients in the smaller balloon group (p= 0.15). Myocardial infarction (Q wave and non-Q wave) complicated 7.7% of procedures in which large balloons were assigned and 3.0% of procedures in which small balloons were assigned (p = 0.056). There were no deaths in either group. The incidence of bypass surgery was 1.7% when the balloon: artery ratio was less than 0.9, 3.1% when the ratio was 0.9-1.1, and 7.8% when it was greater than 1.1. Stepwise logistic regression analysis demonstrated that larger balloon assignment, multiple lesion dilatation, and multivessel coronary artery disease were independent predictors of emergency surgery. Angiographic restudy rates were 50% in the larger group and 60% in the smaller group (p = NS). Mean restudy diameter stenosis was 43 26% versus 47 28% (p = NS). Thirty-three of 84 (39%) restudied patients had restenosis in the large balloon group and 45 of 102 (44%) in the smaller group (p=NS). We conclude that satisfactory initial results can be achieved by conservative sizing of balloon catheters and attention to other dilatation details such as inflation pressure and times. The intention to reduce restenosis by oversizing balloons will result in increased complications, particularly in patients with multivessel disease or complex lesion morphology. (Circulation 1988;78:557-565) R estenosis after percutaneous transluminal coronary angioplasty (PTCA) is strongly influenced by incomplete initial dilatation.1-4From the Andreas