Prognostic value of slow resolution of ST-segment elevation following successful direct percutaneous transluminal coronary angioplasty for recovery of left ventricular function.

Our objective was to investigate the significance of the slow resolution of ST-segment elevation following a successful direct percutaneous transluminal coronary angioplasty (PTCA). ST-segment elevations were calculated from electrocardiograms recorded before PTCA and 1 hour after reperfusion. Forty-nine patients experiencing their first anterior acute myocardial infarction and who had undergone direct PTCA were classified into 3 groups: 17 patients with rapid ST resolution (group I), 23 patients with persistent ST elevation (group II), and 9 patients with ST reelevation (group III). Left ventricular function was evaluated by using single-plane cineventriculography performed in the acute stage, at discharge, and 4 months later. Peak creatine kinase activity was significantly increased: group III (4,046 +/- 634 IU), group II (3,336 +/- 772 IU), and group I (2,410 +/- 994 IU); p <0.05. Ejection fraction and regional wall motion in the acute stage were identical in each group. However, they were significantly higher in group I (67 +/- 6%, -1.01 +/- 0.30), followed by group II (56 +/- 6%, -1.90 +/- 0.41) and group III (38 +/- 7%, -2.79 +/- 0.46); p <0.01 4 months later. Multiple regression analysis revealed that the ST resolution was the only significant variable that indicated the recovery of regional wall motion. A good linear correlation was documented between the ST resolution and the recovery of regional wall motion. We concluded that a slow ST resolution after successful direct PTCA is a negative predictor of recovery of left ventricular function, especially when ST reelevation is evident.

Elastic recoil following percutaneous transluminal coronary angioplasty and Palmaz-Schatz stent implantation.

The post-procedural elastic recoil in 133 lesions treated with the Palmaz-Schatz stent was compared to 133 matched lesions treated with balloon angioplasty to determine the role of prevention of elastic recoil in the creation of a larger initial luminal diameter. Elastic recoil was defined as the difference between the maximal diameter of the inflated balloon and the minimal luminal diameter of the dilated segment immediately after the procedure and was evaluated by quantitative coronary angiography. Overdilatation was defined as a dilatation induced by a balloon with a maximal diameter larger than the pre-procedure reference diameter. The percent diameter stenosis was reduced from 73% to 31% in the balloon angioplasty group and from 72% to -4% in the stent group (31% vs. -4%, p < 0.01). Elastic recoil was significantly larger in the balloon angioplasty group than in the stent group (0.94 +/- 0.29 mm vs. 0.09 +/- 0.09 mm, p < 0.01). Overdilatation and lesion morphology had no significant effects on elastic recoil in the stent group. In the balloon angioplasty group, overdilatation, noncalcified lesions and eccentric lesions were associated with increased elastic recoil. These results indicated that the larger post-procedural luminal diameter associated with the Palmaz-Schatz stent was primarily the result of prevention of elastic recoil, which was not influenced by the degree of overdilatation or lesion morphology.

[Outcome of coronary angioplasty and coronary artery bypass grafting in patients over 75 years old].

Mortality, morbidity, and 3-year survival rates were evaluated in patients aged over 75 years undergoing initial revascularization by percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG). The groups of 74 patients undergoing PTCA and 27 undergoing CABG had similar clinical characteristics including age, sex, emergency operation, prior myocardial infarction, and ejection fraction. The PTCA group contained significantly more patients with single vessel disease (44% vs 8%, p < 0.01) while the CABG group had more three-vessel or left main trunk disease (30% vs 70%, p < 0.01). The patients in the PTCA group demonstrated more prior cerebral vascular events, renal insufficiency, and abdominal aortic aneurysms. Angiographic revascularization was achieved in 112 of 130 lesions (86%) and in 63 of the 74 (84%) patients in the PTCA group. Hospital mortality for the PTCA group was 5.4% (two cardiac deaths and two non-cardiac deaths), but 0% for the CABG group. Myocardial infarction occurred in 1.3% and 3.7%, respectively (p = NS). Three-year survival, excluding hospital deaths, was 90% for patients with PTCA and 96% for those with CABG (p = NS). All these deaths were of non-cardiac origin. Both PTCA and CABG are safe and effective for selected patients over the age of 75 years.