Effectiveness of percutaneous transluminal coronary angioplasty for patients with medically refractory rest angina pectoris and high risk of adverse outcomes with coronary artery bypass grafting

Morrison, Douglass A.; Sacks, Jerome; Grover, Frederick L.; Hammermeister, Karl E.

doi:10.1016/0002-9149(95)80027-p

Cited by 13 publications

(3 citation statements)

References 30 publications

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“…Patients undergoing PTCA rather than CABG would avoid the risks of general anesthesia, CPB, median sternotomy, cardioplegic arrest, mechanical ventilation, nonpulsatile flow, and large vascular to extravascular volume shifts. 9 Several large, prospective randomized trials have compared PTCA to CABG in relation to short-and intermediate-term mortality rates, MI, and relief of ischemia in response to exercise testing, and all have been comparable to those of CABG. 10 The knowledge of how well PTCA relieves symptoms and improves quality of life is integral to the daily clinical decision making process.…”

Section: Treatment Therapiesmentioning

confidence: 99%

“…10 The knowledge of how well PTCA relieves symptoms and improves quality of life is integral to the daily clinical decision making process. Considerations for making this decision should include the following four factors: (1) number of significantly diseased coronary arteries; (2) left ventricular systolic function; (3) hemodynamic stability vs instability; (4) degree to which coronary anatomy is thought to be favorable for CABG, PTCA or both (9). If the number of diseased vessels is less than two, then the option for PTCA is considered the preferred treatment for those patients, with advantages contending with the benefits from CABG.…”

Section: Treatment Therapiesmentioning

confidence: 99%

“…In the case of an ejection fraction below 35%, CABG would be the preferred revascularization treatment. 9 Patients entering the operating room with vessel occlusions which severely depress the myocardial reserve are considered hemodynamically unstable for PTCA. 10 PTCA is deemed appropriate for cardiac patients with medically refractory unstable angina in the case where CABG surgery would adversely affect outcome.…”

Section: Treatment Therapiesmentioning

confidence: 99%

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Patient outcome as a selection criterion in determining treatment mode

Ninni¹,

Brownstein

1999

Perfusion

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The climate of health care reform encourages scrutiny of traditional and new forms of medical and surgical therapy. With the emergence of technologically innovative cardiac procedures, therapy advocates must weigh cost versus patient outcomes. Therapies range from purely medical management, through staged interventions, to median sternotomy and cardiopulmonary bypass. Outcomes will necessarily be related to quality of life. A literature search was performed to determine types of medical and surgical therapies associated with patient outcomes as they define quality of life. Medical treatment may include the use of anti-platelet therapy, beta-blockers and diuretics to treat the cardiac patient at low risk who can maintain an acceptable quality of life. Improvements in medical therapies may extend the life of the low-risk patient, eliminating the need to consider bypass surgery. Some patients at high risk, or with left ventricular hypertrophy combined with an impaired ejection fraction, may require coronary artery bypass surgery. Studies indicate that patients undergoing open heart surgery demonstrate significant improvement in functional classification, increased activity and reduction in anti-anginal medications. Proponents of minimally invasive surgery claim potential benefits of lower surgical trauma, shorter hospital stays and shorter recovery times. Quality of life is defined by outcomes. Only by comparing outcomes of all available therapies can a physician or patient make an informed decision regarding treatment.

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Section: Treatment Therapiesmentioning

confidence: 99%

Section: Treatment Therapiesmentioning

confidence: 99%

Section: Treatment Therapiesmentioning

confidence: 99%

See 1 more Smart Citation

Patient outcome as a selection criterion in determining treatment mode

Ninni¹,

Brownstein

1999

Perfusion

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Angioplasty and stenting of an unprotected left main bifurcation lesion

Morrison

Rumsfeld

Gibson

1997

Cathet. Cardiovasc. Diagn.

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In‐hospital outcomes of contemporary percutaneous coronary interventions in the very elderly

Dynina

Vakili

Slater

et al. 2003

Cathet Cardio Intervent

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Coronary heart disease is the leading cause of death among the elderly (> 65 years) and the very elderly (> 85 years). Little information is available regarding the outcome of very elderly patients referred for PCI in the current era of improved techniques, devices, and pharmacotherapy. The objective of the current study was to evaluate the clinical characteristics and outcomes of very elderly patients > or = 85 years of age in a large, contemporary, multi-institutional PCI database. Five hospitals in the New York City metropolitan area contributed these prospectively defined data elements on consecutive patients undergoing PCI from 1 January 1998 to 1 October 1999. Of 10,847 patients, 5,341 (49%) were younger than 65 years, 3,342 (31%) were 65-74 years, 1,885 (17%) were 75-84 years, and 279 (2.6%) were at least 85 years of age. Following PCI, the very elderly developed stroke (P < 0.001) and renal failure requiring dialysis (P = 0.002) more commonly than younger patients following PCI. The very elderly had a significantly increased in-hospital mortality rate at 2.5% (P < 0.001). However, on multivariate analysis, age > or = 85 years was not an independent predictor of in-hospital mortality (OR = 1.22; 95% CI = 0.37-4.07). The very elderly should not be refused PCI on the basis of advanced age alone.

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Effectiveness of percutaneous transluminal coronary angioplasty for patients with medically refractory rest angina pectoris and high risk of adverse outcomes with coronary artery bypass grafting

Cited by 13 publications

References 30 publications

Patient outcome as a selection criterion in determining treatment mode

Patient outcome as a selection criterion in determining treatment mode

Angioplasty and stenting of an unprotected left main bifurcation lesion

In‐hospital outcomes of contemporary percutaneous coronary interventions in the very elderly

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