A Comparison of Angioplasty With Medical Therapy in the Treatment of Single-Vessel Coronary Artery Disease

Parisi, Alfred F.; Folland, Edward D.; Hartigan, Pamela

doi:10.1097/00008483-199205000-00013

Cited by 156 publications

(181 citation statements)

References 0 publications

Supporting

Mentioning

163

Contrasting

Unclassified

Order By: Relevance

“…13 In the absence of blinding, the effect size of PCI on symptomatic endpoints can be overestimated because of the addition of the placebo effect to the true physiological effect of intervention.14 In all previous trials, both investigators and patients were aware of the treatment allocation. 2,8,10 Research in context Evidence before this study More than 500 000 percutaneous coronary interventions (PCIs) are done annually worldwide for the relief of angina but no placebo-controlled trials have been done on the subject. Unblinded PCI is reported to increase exercise time by 96 s more than medical therapy.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial

et al. 2018

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial

et al. 2018

View full text Add to dashboard Cite

show abstract

“…1 Although they are life-saving in selected cases, 2 the main benefits of these procedures are relief of angina and improved quality of life. 3,4 Although considerable research has been directed at improving the outcomes of percutaneous coronary revascularization, these studies have generally focused on "hard" end points such as procedural complications 5 or angiographic restenosis. 6 Few studies have examined factors that influence health-related quality of life after PTCA, however.…”

mentioning

confidence: 99%

Impact of Smoking on Health-Related Quality of Life After Percutaneous Coronary Revascularization

Taira

Seto

et al. 2000

Circulation

View full text Add to dashboard Cite

Background-PTCA is performed primarily to improve health-related quality of life (HRQOL) in patients with symptomatic coronary artery disease. In patients undergoing PTCA, smoking has been shown to increase risks of late myocardial infarction and death. Whether smoking also affects HRQOL after PTCA is currently unknown. Methods and Results-We examined the relation between smoking status and HRQOL among 1432 patients who underwent PTCA as part of 2 multicenter clinical trials. HRQOL was assessed with the use of the Medical Outcomes Study SF-36 questionnaire. Patients were classified as smokers (nϭ301), quitters (nϭ141), or nonsmokers (nϭ990) on the basis of their smoking status at the time of their index procedure and during the first year of follow-up. For the overall population, HRQOL improved significantly after PTCA for all scales except general health perception, with improvements ranging from 5.5 points for mental health to 23.2 points for role-physical functioning. After adjustment for baseline characteristics and initial HRQOL, nonsmokers had gains at 6 months that were larger than those of smokers for all health domains: physical function (15.4 versus 10.4 points), role-physical (24.5 versus 13.9), pain (18.4 versus 13.3), general health perception (1.7 versus Ϫ4.5), vitality (11.0 versus 4.7), social function (12.8 versus 3.5), role-emotional (13.5 versus 6.7), and mental health (6.8 versus 0.8; PϽ0.02 for all comparisons). Quitters had 6-month HRQOL improvements that were greater than those in smokers for all domains as well. Findings were similar at 1 year. Conclusions-Quality-of-life benefits of PTCA are diminished by continued smoking. Efforts to promote smoking cessation at the time of PTCA may substantially improve the health outcomes of these procedures. (Circulation.

show abstract

“…This is of significant socioeconomic import, given the cost of percutaneous revascularization and the fact that randomized trials of medical management versus angioplasty have not shown a survival advantage for treatment of stable angina, unstable angina, or non-Q-wave MI with PTCA. [5][6][7] The broader application of PTCA between 1989 and 1995 was accompanied by increased in-hospital mortality. One explanation for this increase is that the expansion in treatment of women, diabetics, the elderly, and patients with a recent MI-all subgroups known to have a higher mortality-leads to higher overall mortality.…”

Section: Discussionmentioning

confidence: 99%

Practice of Coronary Angioplasty in California in 1995

Rill

Brown

1999

Circulation

View full text Add to dashboard Cite

Background —This study seeks to analyze changes in the practice of PTCA in California between 1989 and 1995 by use of the Office of Statewide Health Planning and Development (OSHPD) data set. Methods and Results —All hospital discharges in 1995 with a procedure code for PTCA or stent were identified. The 1995 PTCA data were compared with previously published data from 1989 obtained from the same database. The number of PTCAs performed increased by 49% between 1989 and 1995, from 24 883 to 37 118. The percentage of female patients increased from 29.8% to 32.7% ( P =0.0001). The percentage of diabetics increased from 14.4% to 21.6% ( P =0.0001) between 1989 and 1995. Procedures on patients with a principal diagnosis of acute myocardial infarction increased from 19.3% of all PTCAs in 1989 to 27.5% of PTCAs in 1995 ( P =0.0001). In-hospital mortality increased from 1.4% in 1989 to 1.9% in 1995 ( P =0.0001). There were 3087 admissions with stent placement in 1995. In-hospital mortality after stent placement was 0.9% ( P =0.0001 versus PTCA). Patients undergoing PTCA in hospitals performing >400 PTCAs in 1995 had a 4% incidence of death or emergency bypass surgery compared with a 6% incidence when PTCAs were performed in hospitals performing ≤400 PTCA in 1995 ( P <0.0001). Patients undergoing stent implantation in hospitals performing >75 stent procedures in 1995 had a 1.3% incidence of death or emergency bypass compared with an incidence of 4% when the procedure was performed in a hospital performing ≤75 stent placements in 1995 ( P <0.0001). Conclusions —The 1995 OSHPD data continue to suggest an inverse relationship between hospital PTCA and stent volume and adverse patient outcomes.

show abstract

A Comparison of Angioplasty With Medical Therapy in the Treatment of Single-Vessel Coronary Artery Disease

Cited by 156 publications

References 0 publications

Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial

Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial

Impact of Smoking on Health-Related Quality of Life After Percutaneous Coronary Revascularization

Practice of Coronary Angioplasty in California in 1995

Contact Info

Product

Resources

About