ABSTRACT
The introduction of coronary stents for the treatment of acute vessel closure has probably improved the safety of angioplasty, but little data are available regarding angioplasty complication rates when bailout stenting is available. Therefore baseline and patient outcome data for 2242 consecutive patients treated at a single tertiary referral center were compared before and after bailout coronary stenting was introduced. Patients treated after stents became available were more likely to have diabetes (16% prestent availability vs 19% poststent, p < 0.05), unstable angina (61% prestent vs 70% poststent, p < 0.01), and to have received intravenous nitroglycerin before the procedure (22% prestent vs 28% poststent, p < 0.01). Major complications occurred in 4.1% of patients before stent availability and 2.0% afterwards (p < 0.01). These complications included in-hospital death (1.1% prestent vs 0.7% poststent, p = not significant [NS]), Q wave myocardial infarction (0.5% prestent vs 0.3% poststent, p = NS), and emergency bypass surgery (2.9% prestent vs 1.1% poststent, p < 0.01). The introduction of coronary stents was associated with a > 50% reduction in major complications despite greater patient acuity. The traditionally reported complication rates for angioplasty appear not to apply when ballout stenting is available.
Subject(s)
Angioplasty, Balloon, Coronary , Coronary Vessels , Stents , Angina, Unstable/complications , Angioplasty, Balloon, Coronary/adverse effects , Coronary Artery Bypass , Coronary Disease/complications , Coronary Disease/therapy , Diabetes Complications , Electrocardiography , Emergencies , Female , Humans , Injections, Intravenous , Male , Middle Aged , Myocardial Infarction/etiology , Nitroglycerin/administration & dosage , Nitroglycerin/therapeutic use , Stents/adverse effects , Survival Rate , Treatment Outcome , Vasodilator Agents/administration & dosage , Vasodilator Agents/therapeutic useSubject(s)
Angioplasty, Balloon, Coronary , Aortic Dissection/therapy , Coronary Aneurysm/therapy , Myocardial Infarction/therapy , Stents , Aortic Dissection/etiology , Angioplasty, Balloon, Coronary/instrumentation , Coronary Aneurysm/etiology , Follow-Up Studies , Humans , Male , Middle Aged , Myocardial Infarction/complicationsABSTRACT
Interventional cardiology has undergone exciting changes since the first percutaneous transluminal coro-_ nary angioplasty was performed by Andreas Gruentzig in 1977.' Over the last several years, a variety of techniques have been developed which provide the interventional cardiologist with a range of options to treat coronary stenoses. In addition, the indications for intervention have radically changed since the original work by Gruentzig, who limited treatment to patients with a single focal stenosis in a large vessel. Advances in balloon angioplasty, as well as the development of new techniques such as directional atherectomy, laser angioplasty, rotational atherectomy, extraction atherectomy, and now intracoronary stents have given the interventional cardiologist the ability to treat multivessel disease, increasingly complex lesions, and less stable patients."
Subject(s)
Atherectomy, Coronary , Intraoperative Complications/epidemiology , Algorithms , Atherectomy, Coronary/adverse effects , Atherectomy, Coronary/statistics & numerical data , Coronary Disease/complications , Coronary Disease/diagnostic imaging , Coronary Disease/surgery , Female , Humans , Incidence , Intraoperative Complications/diagnostic imaging , Intraoperative Complications/etiology , Male , Radiography , Risk FactorsABSTRACT
We analyzed disease-marker associations in Problem 3 for the Genetic Analysis Workshop II, using PAP for segregation analysis and LIPED for linkage analysis. In this report we present aspects of our analyses that are not reported in the summary [MacCluer et al, 1984]. Certain features that we added to the running of LIPED to facilitate the analysis are discussed. Furthermore, we tested for Mendelian transmission in the hypothetical trait locus and we calculated modified relative risks for marker-trait genotypes. Some of the problems involved in analyzing complex associations among loci are discussed.
