Percutaneous transluminal coronary angioplasty in King Chulalongkorn Memorial Hospital: a four-year experience.

ABSTRACT

From January 1993 to December 1996, 461 cases (743 lesions) of percutaneous transluminal coronary angioplasty (PTCA) were performed at King Chulalongkorn Memorial Hospital. Seventy eight per cent of the patients were male. Mean age was 61.1 +/- 9.6 yrs and mean ejection fraction was 0.59 +/- 0.18. The indications for PTCA were chronic stable angina (53%), post myocardial infarction (MI) angina (26.6%), unstable angina (17.4%) and acute MI (3%). Emergency PTCA was performed on 15 cases with 5 patients in cardiogenic shock. Fifty four per cent of the cases were performed in single vessel disease, 33 per cent in double vessel disease and 13 per cent in tripple vessel disease. The vessels dilated were the left anterior descending artery (44.2%), right coronary artery (27.8%), left circumflex artery (26.7%), left main (0.9%) and saphenous vein graft (0.4%). Mean balloon size was 2.48 mm. The overall success rate of PTCA, defined as residual diameter stenosis less than 50 per cent, was 91.5 per cent. In addition to PTCA, 123 stent implantations with mean stent size 2.98 mm and 15 rotational athrectomy were done in 114 cases. Complications of PTCA occurred in 32 cases (6.9%). Ten patients (2.2%) had abrupt closure, 1 of these needed emergency coronary bypass graft surgery (CABG). One patient (0.2%) had cerebral embolism with minor residual neurological deficit. One patient (0.2%) had toe gangrene which eventually needed amputation. One patient (0.2%) who presented with acute extensive anterior wall MI and failure of thrombolytic therapy died 8 hours after successful PTCA due to refractory cardiogenic shock. In the patients who also had stent implantation, there were 6 stent misplacements 3 in the right femoral artery without any complication, 2 were misplacements in the coronary system and 1 dislodged in LM necessitating emergency CABG. CONCLUSION: PTCA is the coronary interventional procedure that can be performed with a high success rate and minimal complications.