Long-term angiographic follow up, cardiac events, and survival in patients undergoing percutaneous transluminal coronary angioplasty.

The results of percutaneous transluminal coronary angioplasty were studied in 1352 consecutive patients. The angioplasty procedure was angiographically successful in 1163 (86%) patients and the success rate increased gradually with time. There were no significant differences in success rates in different vessels or indications. The success rate for repeat coronary angioplasty was 92%. In 85% of the patients the clinical course was uncomplicated. Myocardial infarction occurred in 3.6%, emergency coronary bypass grafting in 2.6%, elective bypass surgery in 4.6%, and there were 10 deaths (0.7%). There were 16 deaths (10 non-cardiac) during follow up in the 1163 patients in whom the first procedure was successful. Actuarial analysis showed that after a first angioplasty 77.9% remained free of symptoms and cardiac events for five years and that after a second angioplasty 76% did so. Angiographic follow up showed restenosis in 24% of patients but the overall clinical success rate was 86.2%. On the basis of the intention to treat the procedure was successful in 74.3% of all 1352 patients. Coronary artery bypass surgery was eventually performed in 11.6% of all patients. The long term angiographic success rate of coronary angioplasty is higher than previously suggested.

Percutaneous transluminal coronary angioplasty in patients with prior coronary artery bypass grafting. Long-term results.

In 83 patients with previous coronary artery bypass grafting, 92 percutaneous transluminal coronary angioplasty attempts were done, 33 in a venous bypass graft (success rate 97%) and 59 in a native coronary artery (success rate 86.4%). There were no procedural-related deaths and two myocardial infarctions. Forty-six percent of the patients with successful angioplasty after previous bypass grafting remain symptom free after 5 years versus 79% of the patients without previous bypass grafting (p less than 0.001). Long-term success rates for native vessel angioplasty as compared with bypass graft angioplasty are similar. Patients with a short interval between the recurrence of angina after bypass grafting and the angioplasty attempt have a better chance of long-term success. Repeat angiography indicates that a restenosis occurs after angioplasty of a venous graft in 31% and in the native system in 28.6% and that signs of progression of coronary artery disease elsewhere are present in 30%. Of the 83 patients, 11 had reoperation eventually. We conclude that percutaneous transluminal coronary angioplasty after coronary bypass grafting gives less satisfactory results than a primary procedure, that angioplasty provides symptomatic relief in a smaller number of patients than in those with primary angioplasty, but that symptomatic relief is often sufficient to further postpone or prevent bypass grafting and can be achieved with low mortality and low complication rates.