Percutaneous Transluminal Coronary Angioplasty in 1985–1986 and 1977–1981

Detre, Katherine M.; Holubkov, Richard; Kelsey, Sheryl F.; Cowley, Michael J.; Kent, Kenneth M.; Williams, David O.; Myler, Richard K.; Faxon, David P.; Holmes, David R.; Bourassa, Martial G.; Block, Peter C.; Gosselin, Arthur J.; Bentivoglio, Lamberto G.; Leatherman, Louis L.; Dorros, Gerald; King, Spencer B.; Galichia, Joseph P.; Al-Bassam, Mahdi S.; Leon, Martin B.; Robertson, Thomas; Passamani, Eugene R.

doi:10.1056/nejm198802043180501

Cited by 762 publications

(77 citation statements)

References 10 publications

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“…1 In 2 large series reported by the National Heart, Lung and Blood Institute, emergency CABG was required in 6% of the cases between 1977 and 1981 and in 3% between 1985 and 1986. 10 There has been an additional decline in the reported prevalence of emergency CABG in the 1990s. In a study of 5655 patients undergoing PCIs by Shubrooks et al, 11 emergency CABG was required in 2.2% of the cases in 1992 to 1993 and 0.6% of the cases in 1997.…”

Section: Discussionmentioning

confidence: 99%

Emergency Coronary Artery Bypass Surgery in the Contemporary Percutaneous Coronary Intervention Era

et al. 2002

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Background-Since the advent of percutaneous coronary interventions (PCIs), technological advances, adjunctive pharmacotherapy, and increasing operator experience have contributed to lowering the occurrence of major complications. However, emergency coronary artery bypass surgery (CABG) for failed PCI is still associated with important morbidity and mortality, even in the era of coronary stenting. We sought to determine the prevalence, indications, predictors, and complications of emergency CABG after PCI in the past decade. Methods and Results-We reviewed 18 593 PCIs performed from 1992 through 2000. There was a need for emergency CABG in 113 (0.61%) cases. The major indications were extensive dissection (nϭ61, 54%), perforation/tamponade (nϭ23, 20%), and recurrent acute closure (nϭ23, 20%). Prevalence of emergency CABG decreased from 1.5% of PCIs in 1992 to 0.14% in 2000 (PϽ0.001). Independent predictors of the need for emergency CABG included the worst ACC/AHA scoring of the intervened lesion (PϽ0.001) and female sex (Pϭ0.028), whereas history of prior bypass surgery and use of stents resulted in a decreased need for emergency CABG (PϽ0.001 for both). In patients undergoing emergency CABG, there were 17 (15%) in-hospital deaths, 14 (12%) perioperative Q-wave myocardial infarctions, and 6 (5%) cerebrovascular accidents. Conclusions-The need for emergency CABG has considerably decreased over time. Risk factors include female sex and a higher ACC/AHA score of the intervened lesion. However, morbidity and mortality of emergency CABG remain high even in the new millennium.

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Section: Discussionmentioning

confidence: 99%

Emergency Coronary Artery Bypass Surgery in the Contemporary Percutaneous Coronary Intervention Era

et al. 2002

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“…In the first NHLBIsponsored PTCA registry, 9% of patients had diabetes mellitus 13 ; in the second registry, this proportion had risen to 12%, 3 and in the Bypass Angioplasty Revascularization Investigation, 19% of patients were diabetic. 2 In contrast, 23% of patients in EPILOG had diabetes.…”

Section: Discussionmentioning

confidence: 99%

Diabetes Mellitus, Glycoprotein IIb/IIIa Blockade, and Heparin

Kleiman

Lincoff²,

Dj³

et al. 1998

Circulation

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Background-After angioplasty, major complications and ischemic events occur more frequently in diabetic than nondiabetic patients. To determine whether treatment with abciximab is effective in reducing these events in diabetics, we analyzed characteristics and outcomes of diabetic patients enrolled in a large multicenter study (EPILOG). Methods and Results-Of 2792 patients enrolled, 638 (23%) were diabetic. Diabetic patients were older, shorter, and heavier; more likely to be female and have three-vessel disease, prior coronary artery bypass graft surgery, a history of hypertension, or a recent myocardial infarction; and less likely to be current smokers than their nondiabetic counterparts. During hospitalization, death, myocardial infarction, or urgent revascularization occurred in 7.1% of diabetics and 7.5% of nondiabetics. By 6 months, the composite of death and myocardial infarction had occurred in 8.8% of diabetic patients and 7.4% of nondiabetics, whereas death, myocardial infarction, or revascularization had occurred in 27.2% and 22.6%, respectively. Abciximab treatment reduced death or myocardial infarction among diabetic and nondiabetic patients (hazard ratios, 0. When standard-and low-dose heparin adjuncts were compared, diabetics receiving abciximab with standard-dose heparin had marginally greater reductions in the composite of death and myocardial infarction and in target vessel revascularization than diabetics assigned to abciximab with low-dose heparin. Conclusions-Abciximab treatment in diabetic patients led to a reduction in the composite of death and myocardial infarction, which was at least as great as that seen in nondiabetic patients. However, target vessel revascularization was reduced in nondiabetic but not diabetic patients. This effect may be associated in part with lower doses of heparin. These differences may be related to differences in the platelet and coagulation systems between diabetics and nondiabetics, the greater extent of coronary artery disease in diabetics, or patient selection and management factors. (Circulation. 1998;97:1912-1920.)

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“…In the United States, Ϸ25% of all patients who undergo PTCA are smokers. 7,8 Several studies have shown that long-term risks of myocardial infarction and death are higher for smokers than for nonsmokers after both percutaneous 8 and surgical coronary revascularization. 9 -11 Moreover, smoking is associated with microvascular endothelial dysfunction that may limit the ability of epicardial revascularization to restore normal coronary blood flow.…”

Section: See P 1340mentioning

confidence: 99%

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

Taira

Seto

et al. 2000

Circulation

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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.

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Percutaneous Transluminal Coronary Angioplasty in 1985–1986 and 1977–1981

Cited by 762 publications

References 10 publications

Emergency Coronary Artery Bypass Surgery in the Contemporary Percutaneous Coronary Intervention Era

Emergency Coronary Artery Bypass Surgery in the Contemporary Percutaneous Coronary Intervention Era

Diabetes Mellitus, Glycoprotein IIb/IIIa Blockade, and Heparin

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

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