Percutaneous transluminal coronary angioplasty: late results at 5 years following intervention.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
A R Gruentzig
Publications and source records attributed to A R Gruentzig.
Percutaneous transluminal coronary angioplasty.
Explore the source record for details and available documents.
Angina Pectoris↗
Sex differences in early and long-term results of coronary angioplasty in the NHLBI PTCA Registry.
To assess whether gender influenced the outcome of percutaneous transluminal coronary angioplasty (PTCA), we analyzed data from the NHLBI PTCA Registry. Early results were compared in 705 women and 2374 men. Women were older (p less than .01) and had more unstable angina (p less than .01), and class 3 or 4 angina (p less than .01). Men had more multivessel disease (p less than .01), prior bypass surgery (p less than .01), and abnormal left ventricular function (p less than .05). Women had a lower angiographic success rate (60.3 vs 66.2%; p less than .01) and had a lower clinical success rate (56.6% vs 62.2%; p less than .01). More women had complications (27.2% vs 19.4%; p less than .01), but overall frequency of major complications (death, myocardial infarction, emergency surgery) was not different (9.8% vs 9.3%). Women had a higher incidence of coronary dissection (p less than .05) and higher in-hospital mortality (1.8% vs 0.7%; p less than .01). PTCA-related mortality was nearly six times higher in women (1.7% vs 0.3%; p less than .001) and mortality with emergency surgery was more than five time higher (17.4% vs 3.2%; p less than .001). Multivariate analysis indicated that female gender was an independent predictor for lower success (p less than .05) and early mortality (p less than .05) and was the only baseline predictor for PTCA-related mortality.(ABSTRACT TRUNCATED AT 250 WORDS)
Age Factors↗
In-hospital morbidity and mortality in patients undergoing elective coronary angioplasty.
We prospectively recorded all in-hospital complications of the first 3500 consecutive patients to undergo elective coronary angioplasty (PTCA) at Emory University Hospitals from July 14, 1980, to August 28, 1984, by three operators. PTCA was attempted in a total of 3933 lesions, with a primary success rate of 91%. Multiple-lesion PTCA was performed in 401 patients, and PTCA of saphenous vein grafts was attempted in 172. No complications were recorded in 3116 (89%) cases, isolated minor complications occurred in 241 (6.9%), and major complications (emergency surgery, myocardial infarction, death) were observed in 145 (4.1%). Emergency coronary artery bypass graft surgery (CABG) was performed in 96 patients (2.7%), with a myocardial infarction rate of 49% (47/96), a Q wave infarction rate of 23% (22/96), and an emergency surgery mortality rate of 2% (2/96). Hospital discharge occurred within 2 weeks of attempted PTCA in 91% (87/96) of patients undergoing emergency CABG. The overall myocardial infarction rate was 2.6% (94/3500). There were two nonsurgical deaths, giving a total mortality rate of 0.1% (4/3500). Univariate and multivariate analysis of 3099 patients undergoing single-lesion PTCA identified five preprocedure predictors of a major complication: multivessel coronary disease, lesion eccentricity, presence of calcium in the lesion, female gender, and lesion length. Unstable angina, duration of angina, lesion severity, previous CABG, and vein graft dilatation were not associated with an increased incidence of major complications. The strongest predictor of a major complication was the procedural appearance of an intimal dissection. Intimal dissection was evident in 894/3099 (29%) patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Angioplasty, Balloon↗
Percutaneous transluminal coronary angioplasty: an update on indications, techniques, and results.
Despite continued efforts at disease prevention, coronary artery disease remains accountable for more than 500,000 deaths per year in the United States. Surgical intervention has assumed a well-deserved role over the past 16 years in disease palliation and receives wide application. More recently, PTCA has emerged as a proven technique for coronary revascularization that can be applied to a large group of patients with coronary artery disease. Clearly complementing bypass surgery, percutaneous dilatation offers certain advantages such as reduced emotional pain and suffering, sizable economic savings, and reduced time lost from work. As diagnostic technology continues to improve, the goal of early disease recognition and gentle nonsurgical resolution may well be accomplished in many individuals suffering from coronary artery disease.
Angioplasty, Balloon↗
Percutaneous transluminal coronary angioplasty (PTCA).
The role of PTCA in the management of coronary artery disease has continued to evolve during the past six years as experience has grown and technical advances have been made. As has been clearly demonstrated in its relatively short history, PTCA offers an effective means of immediate palliation in symptomatic coronary artery disease. The natural history of coronary artery disease is one of progression and the ideal therapy is one which can be used repeatedly through the years. Advances in diagnostic technique hopefully will enable physicians to intervene earlier in the course of the disease, prior to the compromise of ventricular function which often accompanies triple vessel disease. The main question, however, is still unanswered and that is whether PTCA is an alternative approach to coronary artery bypass graft surgery in patients with multivessel disease. Preliminary reports indicate safety and good results may be obtained when PTCA is performed in these patients. However, the true usefulness and exact role needs to be carefully determined in a randomized study comparing coronary artery bypass surgery and PTCA in patients with multivessel disease. Hopefully in the future, patients with coronary artery disease can be diagnosed early before their disease progresses to severe triple vessel disease, when it may be too late for PTCA.
Angioplasty, Balloon↗
Significance of early chest pain after coronary angioplasty.
In summary, coronary angioplasty has proved to be an alternative to bypass surgery in relieving angina in selected patients. Unfortunately, some patients experience early transient chest pain during their hospitalization. Early prolonged chest pain with electrocardiographic changes requires nursing attention because it may represent an acute complication of PTCA requiring immediate medical intervention.
Adult↗
Long-term efficacy of percutaneous transluminal coronary angioplasty (PTCA): report from the National Heart, Lung, and Blood Institute PTCA Registry.
The NHLBI PTCA Registry has collected data from 3,079 patients who underwent PTCA at 105 centers from September 1977 through September 1981 that document the initial risks and benefits of PTCA. A subgroup of 2,272 patients at 65 centers was chosen to examine the long-term effects of PTCA (97% follow-up). All patients were followed for 1 year, 191 for 3 years and 57 for 4 years. Initial success occurred in 1,397 (61%), and 72% remained improved at 1 year with no further procedures; during the first year of follow-up, 14% had repeat PTCA, 12% had CABG, 3% had MI and 1.6% died. After 1 year, 67% were asymptomatic; of these, 52% had no other procedure, 7% had a second PTCA and 8% had CABG. Follow-up at 2 to 4 years was similar except that there were few repeat PTCA or CABG procedures after 1 year. The annual mortality rate after PTCA in patients with 1-vessel diseases was less than 1% per year and with multivessel CAD, 3% per year. Thus, successful PTCA alone results in sustained improvement in 84% of patients; 59% were asymptomatic (12% had repeat PTCA). PTCA offers extended effective therapy in selected patients with CAD.
Angioplasty, Balloon↗
Efficacy of repeat percutaneous transluminal coronary angioplasty for coronary restenosis.
The short- and long-term outcome of patients within the NHLBI PTCA Registry who underwent repeat PTCA for coronary restenosis were analyzed. Of 1,880 patients in whom an initial PTCA was successful, 203 had a repeat PTCA attempted after restenosis developed. Repeat PTCA was usually performed within 6 months of the first procedure. The success rate of repeat PTCA was 85.2%. As a direct result of repeat PTCA, 1.5% of patients had an MI and 2% required emergency CABG. No patient died as a result of the attempted second procedure. One to 3 years of follow-up information was available in 94% of eligible patients. Most patients (75.9%) did not have a subsequent (third) PTCA, CABG or an MI. The late mortality rate was 0.8%. Angiographic follow-up information was available in 62 patients. Sustained enhancement of the diameter of the redilated lesion was observed in 66%. Thus, repeat PTCA has a high success and a low complication rate. Most patients did not have subsequent restenosis and are free of angina. Hence, repeat PTCA should be recommended for patients who have restenosis and should be considered as an integral component of PTCA therapy.
Angina Pectoris↗
Relative cost of coronary angioplasty and bypass surgery in a one-vessel disease model.
A national study was carried out to determine the relative costs of PTCA and CABG. Baseline clinical criteria for the 2 groups were similar. Data were collected in 186 sets for the PTCA group and 175 sets for the CABG group. Male patients make up 81% of the PTCA group and 80% of the CABG group. Mean hospital stay was 12 +/- 5 days in the CABG group, compared with 4 +/- 2 days in the PTCA group (p less than 0.001). The base charges for hospital and professional components of the CABG procedure were $15,580 +/- $2,159, whereas the same charges for the PTCA procedure were $5,315 +/- $2,159 (p less than 0.001). With an 80% primary success rate, which was the group mean success rate, the average dollar savings per PTCA procedure would be $7,149, or $7,149,000 per 1,000 cases. Thus, PTCA for revascularization in 1-vessel CAD is significantly more cost-effective than CABG in the short term.
Aged↗
Effect of investigator experience on percutaneous transluminal coronary angioplasty.
The NHLBI PTCA Registry collected clinical data on 3,101 PTCA procedures performed at 105 clinical centers between September 1977 and September 1981. To investigate the "learning curve" from introduction through the early application of this new therapy for revascularization, success rates and complication rates were examined by calendar year and according to investigator experience. Success rates improved by calendar year, from 54% in 1979 to 66% in 1981. Investigators with fewer than 50 cases had a success rate of 55%. After an investigator had performed 150 procedures, the success rate was 77%. The increase in success rate was largely the result of a dramatic increase in the ability to cross the narrowing with the catheter, and was accounted for by experience and improved equipment. Patient selection for PTCA was characterized by sex, age, previous CABG, number of diseased coronary arteries and stable Canadian Heart classification over time. Reflecting the increase in the success rate was the decrease in the need to perform elective CABG. Emergency CABG, death and MI rates were low (1% mortality, 5% nonfatal MI) and did not change significantly with time or with investigator experience.
Angina Pectoris↗
Learning curve for percutaneous transluminal coronary angioplasty: skill, technology or patient selection.
As with all sophisticated techniques, operators who perform PTCA show a learning curve. It can best be visualized by observing changes in success rate with growing numbers of patients. Thus, the current success rate and complication rate of a particular operator may permit an estimate of the accumulated number of patients treated by that operator. Most likely, the learning curve is also reflected in the rate of long-term success, although it may be obscured by other factors in the variable natural course of CAD. The initial steep upslope of the learning curve is mainly caused by the growing skill of the particular operator. The later, flatter part appears to be secondary to improvements in technical equipment, which take more time. Patient selection has 2 effects on the learning curve that may be self-compensating. If lessons from the past are used for selection and conservatism is preserved, the learning curve will become more pronounced.
Angioplasty, Balloon↗
Restenosis after percutaneous transluminal coronary angioplasty (PTCA): a report from the PTCA Registry of the National Heart, Lung, and Blood Institute.
The results of follow-up angiography in patients from 27 clinical centers enrolled in the PTCA Registry were analyzed to evaluate restenosis after PTCA. Of 665 patients with successful PTCA, 557 (84%) had follow-up angiography (median follow-up 188 days). Restenosis, defined as an increase of at least 30% from the immediate post-PTCA stenosis to the follow-up stenosis or a loss of at least 50% of the gain achieved at PTCA, was seen in 187 patients (33.6%). The incidence of restenosis in patients who underwent follow-up angiography was highest within the first 5 months after PTCA. Restenosis was found in 56% of patients with definite or probable angina after PTCA and in 14% of patients without angina after PTCA. Twenty-four percent of patients with restenosis did not have either definite or probable angina. Multivariate analysis selected 4 factors associated with increased rate of restenosis: male sex, PTCA of bypass graft stenosis, severity of angina before PTCA and no history of MI before PTCA.
Angioplasty, Balloon↗
Current status of dilatation catheters and guiding systems.
Both balloon catheters and guiding catheters for PTCA are high-quality instruments with an advanced degree of reliability and practicality. The standard set-up at Emory University consists of a steerable 3.0-mm balloon catheter and a Judkins-type guiding catheter.
Angioplasty, Balloon↗
Risk of side branch occlusion during coronary angioplasty.
To assess the risk of side branch occlusion during percutaneous transluminal coronary angioplasty (PTCA), 600 consecutive procedures were analyzed. On the basis of pre-PTCA angiograms of 557 patients in whom the balloon was actually inflated, 365 side branches in 302 patients (54% of patients) were deemed in jeopardy. A total of 122 side branches in 102 patients (18%) originated from the lesion segment itself, i.e., their take-off was narrowed (Group I, 33% of side branches at risk), whereas 243 side branches in 214 patients (38%) originated from the immediate vicinity of the stenosis in a way that they were subjected to temporary occlusion during balloon dilatation (Group II, 67% of side branches at risk). Patency of side branches was determined by consensus of 2 observers. Criteria for occlusion were disappearance, filling by collaterals, or stagnation of flow. After PTCA, 20 of 365 side branches (5%) were occluded and associated with chest pain in 5 patients, creatine kinase increase in 6, left anterior hemiblock, septal Q waves and transient atrial fibrillation in 1 and non-sustained ventricular tachycardia in 1 of the 20 patients. Exercise tolerance did not decrease. No local predilection for side branch occlusion was evident. Seventeen of 122 side branches (14%) occluded in Group I, compared with 3 of 243 (1%) in Group II (p less than 0.001). Thus, more than half of the patients who underwent PTCA had side branches at risk for iatrogenic occlusion.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Higher balloon dilatation pressure in coronary angioplasty.
The advent of improved balloon catheters for percutaneous transluminal coronary angioplasty (PTCA) in 1981 extended the theoretic pressure range available for dilatation from 7 atm to 13 atm. The impact of higher dilatation pressure on results of PTCA was studied. The last 100 consecutive patients treated exclusively with the old balloon type (low-pressure group) were compared to the first 100 consecutive patients treated exclusively with the new balloon type (high-pressure group). There was no difference in age, sex, artery distribution, initial degree of stenosis, and initial pressure gradient between the two groups. The mean peak pressure applied was 7.0 +/- 1.6 atm in the low-pressure group and 8.5 +/- 2.1 atm in the high-pressure group (p less than 0.001). The average balloon diameter used and the number and duration of balloon fillings were similar in both groups. Primary success, complications, and residual degree of stenosis were not different in the two groups. The residual pressure gradient, however, was significantly lower in the high-pressure group (11 +/- 7 mm Hg) than in the low-pressure group (16 +/- 10 mm Hg) (p less than 0.01). This indicates a better immediate hemodynamic result without increased risk. It is concluded that it is safe to perform PTCA with the new balloon types allowing for higher pressures. The increment in average pressure used for dilatation, which occurred incidentally, improved the average hemodynamic outcome. This may influence recurrence rate and deserves further investigation by randomized trials.
Angioplasty, Balloon↗
Percutaneous transluminal coronary angioplasty: six years' experience.
It can be foreseen that with properly selected cases, percutaneous transluminal coronary angioplasty will have the same primary and long-term results as bypass surgery in this subset of patients. The socioeconomic and psychologic advantages of the procedure, compared to the advantages of heart surgery, are obvious. The classic indication for the procedure is single-vessel disease. At the present level of experience and case selection, approximately 10% of the surgical candidates could undergo dilatation. If patients with discrete proximal stenosis in double-vessel disease are included, the number will be slightly higher. Future developments in technique, as well as an increase in experience, will broaden the spectrum of this promising treatment.
Angioplasty, Balloon↗
Percutaneous transluminal coronary angioplasty in patients with prior coronary bypass surgery.
Explore the source record for details and available documents.
Adult↗