Among 268 patients undergoing percutaneous transluminal coronary angioplasty between February 1980 and January 1983, a total of 21 patients had variant angina, documented before angioplasty in 14 and after angioplasty in 7. Before angioplasty, all 21 patients had rest angina and 17 also had effort angina; single vessel coronary artery disease with 60 to 95% stenosis was present in all patients and the left anterior descending coronary artery was involved in all but 3 patients. Coronary angioplasty was successful in 19 patients (90%). Eight of the 19 patients remained symptom-free without coronary restenosis after successful angioplasty; in the other 11 patients, angina reappeared within 4 months, usually in association with restenosis. Of the nine patients with coronary restenosis, six had repeat angioplasty (five successful procedures and one failure), two received medical therapy and one underwent coronary bypass surgery. Patients in whom calcium channel antagonists were discontinued immediately after angioplasty had an exceedingly high coronary restenosis rate (8 [80%] of 10 successful attempts), but when calcium antagonists were continued for an average of 6 +/- 4 months after angioplasty, the restenosis rate was low (3 [21%] of 14 successful attempts). After a mean (+/- SD) follow-up period of 33 +/- 13 months, 1 patient had died and the 20 others (95%) were symptom-free; among these 20, 15 patients (75%) had been taking no antianginal drugs for more than 1 year, 2 still received calcium channel antagonists and 3 had had coronary bypass surgery. Repeat coronary arteriography performed 14 +/- 7 months after angioplasty in the 17 patients without angioplasty-related infarction or surgery showed 50% or less coronary stenosis in 13 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
SUMMARY The diagnostic value of exercise electrocardiography using 14 leads and thallium-201 scintigraphy were evaluated in 54 of 70 patients who underwent percutaneous transluminal coronary angioplasty (PTCA), both in the initial assessment and serial follow-up of patients after PTCA. Of the 45 patients who had successful PTCA, 36 had complete noninvasive studies performed before and 1 month after PTCA. Thirty-three of these 36 were asymptomatic 1 month after PTCA; the number of patients with an abnormal exercise ECG decreased from 20 to seven (p < 0.01) and with an abnormal thallium-201 scintigram from 21 to six (p < 0.001); the number of patients who had at least one of the two tests positive decreased from 26 to 10. The average treadmill time increased from 448 + 183 to 618 119 seconds (i < 0.001), and the average rate-pressure product increased from 19.81 ± 6.4 to 31.35 4.6 units x 10 (p < 0.001). Of the 10 patients with a positive test, two had a partial restenosis 50% but < 70% on the 6-month control angiogram; two had a residual stenosis ¢ 50% in a vessel that was not dilated and three had an abnormal scintigram before and 1 month after PTCA that subsequently became negative at 6 months. Six months after PTCA, a control angiogram was performed in 20 asymptomatic patients; 18 had an excellent PTCA result and two had a partial restenosis ¢ 50% but < 70%. The stress test results were normal in patients with a successful 6-month PTCA and abnormal in the two patients with a partial restenosis.Ten patients redeveloped angina within 3 months of PTCA; nine developed a restenosis ¢ 60% and one had a 90% left circumflex stenosis that could not be dilated or grafted. Six of the 10 patients had a normal exercise ECG and scintigram at 1 month that became abnormal when symptoms reappeared. The ratepressure product before PTCA and when angina symptoms recurred was similar (18.00 ± 2.20 vs 23.58 + units x 103) (NS).In conclusion, the use of clinical symptoms in conjunction with the physiologic data, ECG and myocardial scintigram acquired during exercise provide important short-term data on the angiographic evolution of PTCA results. The noninvasive tests may be useful in determining guidelines for repeat angiography in patients who have had PTCA.PERCUTANEOUS transluminal coronary angioplasty (PTCA) is a new technique that may be useful in the treatment of 5-10% of patients with coronary artery disease who are suitable candidates for coronary artery bypass grafting. 1-3However, the method is still considered an investigational procedure and many issues are not resolved.)7 Most reported series of PTCA are small and follow-up is short because the technique requires considerable expertise, is relatively new, and suitable patient recruitment is limited in most hemodynamic laboratories. The role of noninvasive diagnostic tests in the selection and serial follow-up of patients who are considered for PTCA is not well defined. In some reports, stress test results and radionuclide studies are not discussed, and in others the sequ...
KEY WORDS: PTCA, restenosis, repeat PTCA, PTCA outcome determinants. (PTCA) Since its introduction' 12 ' successful percutaneous long-term success of PTCA. Reported restenosis transluminal coronary angioplasty (PTCA) has rates (14-47%) vary, depending in part on the denbeen shown to relieve angina and myocardial nition used, but according to the larger series' 18 " 22 ', ischaemia as assessed by exercise electrocardiogone patient in three with successful PTCA must raphy 13 ', thallium scintigraphy* 3 ' 4 ', and measureexpect recurrence, most of them within 6-8 months ment of coronary blood flow and myocardial after the intervention. Repeat PTCA has been metabolism' 5 ' 6 '. The original indications' 2 ' have been done with a higher primary success rate and fewer expanded' 7 " 171 . But regardless of selection criteria, complications than the initial procedure. Nevertherestenosis with recurrence of myocardial ischaemia less, there remains a substantial rate of second and symptoms remains the major problem limiting recurrences' 23 " 251 . The presence of angina as an indicator for restenosis has a predictive accuracy of only 56% Submitted for publication on 23 June 1986 and in revised form 21 after first and 67% after Second PTCA according tO OctobCTl986 the NHLBI report" 8231 . One patient in four with For the period that this work was carried out, Dr Rapold was restenosis has no chest pain. In a population at high supported by a grant oftheSwisi National Science Foundation. Restenosis is the main problem limiting long-term success of percutaneous transluminal coronary angioplasty
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.