Coronary angioplasty at the time of initial diagnostic coronary angiography in patients with unstable angina

Abstract

Of the last 200 consecutive patients undergoing PTCA procedures at our institution, 29 (15%) had unstable angina; and angioplasty was performed at the time of diagnostic coronary arteriography. There were 26 males and three females with an age range of 31-82 (mean 57) years. Factors favoring PTCA at the time of initial coronary arteriography included clinical indications for revascularization, appropriate anatomy based on high-quality fluoroscopy, and availability of emergency surgery if required. Of 34 coronary lesions in 29 patients, 19 involved the anterior branch of the left anterior descending coronary artery (LAD), eight the circumflex branch (Cx); and seven the right coronary artery (RCA). Five patients had two vessels dilated (one LAD + RCA, two LAD + Cx, and two RCA + Cx). Of the coronary artery lesions, 19 were concentric, seven were eccentric, 20 were single and discrete, six were long or multiple in the same vessel; eight vessels were totally occluded, and in nine patients there was good collateral circulation. Twenty-nine (85%) arteries were successfully dilated. Of the unsuccessful cases, one was from failure to cross a totally occluded lesion, and three residual lesions and/or postdilatation pressure gradients remained significant. One patient required emergency aortocoronary bypass surgery because of total occlusion of the LAD immediately post-PTCA. There were no postprocedural myocardial infarcts or deaths. It is concluded that, in selected patients with unstable angina, PTCA can be performed successfully and with low risk at the time of initial diagnostic coronary arteriography. This approach offers certain clinical financial advantages.

Ad hoc coronary intervention

“…This increased to 22.5% in 1995, with the percentage of ad hoc interventions ranging from 0% to 86% among individual laboratories. Older reports document lower incidences of ad hoc intervention in the 12%-23% range [1,2,4,8,9], whereas reports since 1991 document incidences in the 52%-83% range [3,5,6].…”

“…Ad hoc coronary intervention is a percutaneous revascularization procedure performed at the same sitting as diagnostic catheterization [1][2][3][4][5][6][7][8]. The alternative to ad hoc coronary intervention is diagnostic catheterization and coronary intervention performed in separate sessions, on the same or different days.…”

“…In most series [1,2,[4][5][6][7][8][9][10], ad hoc coronary intervention was performed only on selected patients, comprising 12%-62% of those undergoing intervention. As the safety of coronary intervention increases in the stent era, the proportion of interventions done on an ad hoc basis may also increase, although the clinical outcome in these patients is not known.…”

SCAI statement on ad hoc versus the separate performance of diagnostic cardiac catheterization and coronary intervention

“…Nine studies examined ad hoc balloon angioplasty before stenting became the dominant procedure [1][2][3][4][5][6][7][8][9]. Among these studies, 12-83% of the PCIs were classified as ad hoc.…”

“…As percutaneous coronary intervention (PCI) has become safer and easier to accomplish, it is now often performed at the time of diagnostic coronary angiography [1][2][3][4][5][6][7][8][9]. The forces behind this trend include convenience for the patient, efficiency for the physician, and possibly cost savings for payers.…”