Percutaneous transluminal coronary angioplasty for angina pectoris after a non-Q-wave acute myocardial infarction

Despite initially favorable prognosis in patients with non-Q-wave acute myocardial infarction (AMI), long-term mortality in this subset of patients appears to be similar to or even greater than that in patients with Q-wave AMI. The relatively poor late prognosis is primarily due to a high incidence of unstable angina and recurrent AMI. Between January 1982 and January 1987, 114 patients with suitable coronary narrowing underwent percutaneous transluminal coronary angioplasty (PTCA) for angina pectoris (present either at rest or during mild exertion, and despite optimal pharmacologic therapy), a median of 31 (range 2 to 362) days after a non-Q-wave AMI. Success was achieved in dilating the obstructed artery in 98 patients (113 of the 129 dilated arteries). Emergency bypass surgery was performed in 7 patients. Mean clinical follow-up of 20 (range 3 to 59) months was obtained in all patients and revealed no deaths. Of the 98 patients with successful PTCAs, 6 (6%) developed a nonfatal recurrent AMI and 62 (63%) were asymptomatic. However, recurrent angina affected 31 patients (32%) and was treated by repeat PTCA (n = 18), coronary bypass surgery (n = 5) or pharmacologic therapy (n = 8). At follow-up, 74% of the patients (73 of 98) were asymptomatic after a successful PTCA and, if necessary, a repeat PTCA, without incidence of recurrent AMI, coronary bypass surgery or death. The high initial success rate, low incidence of subsequent death and late recurrent AMI and sustained symptomatic benefit suggest that PTCA is an effective initial treatment strategy in these selected patients.     

Results of percutaneous transluminal coronary angioplasty for angina pectoris early after acute myocardial infarction

Between May 1980 and July 1985, 70 patients underwent percutaneous transluminal coronary angioplasty (PTCA) for angina occurring 24 hours after and within 30 days of acute myocardial infarction (32 with Q-wave infarction and 38 with non-Q-wave infarction). One-vessel disease was present in 42 (60%) and multivessel in 28 (40%); the mean ejection fraction was 0.56 (greater than or equal to 0.50 in 77% of patients). PTCA was successful in 56 patients (80%) and after introduction of steerable dilating systems in February 1983 this rate became 86%. The success rate for complete occlusions was 76%. The interval from myocardial infarction to PTCA was similar in patients with successful dilation (12.7 +/- 8.1 days) and those without (13.4 +/- 8.0 days). PTCA failed in 14 patients (20%); 8 underwent emergency coronary artery bypass for acute occlusion and 4 of 6 patients whose lesions could not be crossed had elective bypass surgery. There was 1 operative death. No patient sustained a Q-wave infarction. Three patients had non-Q-wave infarctions after technically successful PTCAs. Mean follow-up was 27 months (6 to 67 months). Of the 56 patients successfully dilated, 14 (25%) had 15 cardiac events during follow-up: death (1), non-Q-wave infarction (2), repeat PTCA (7), coronary bypass (4) and recurrence of severe angina (1). The cumulative mortality was 3% and the reinfarction rate was 7% (no Q-wave reinfarctions). Forty-two (60%) of the 70 patients were free of complicating events acutely and during follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)     

Percutaneous transluminal coronary angioplasty after non-Q-wave acute myocardial infarction

The value of percutaneous transluminal coronary angioplasty (PTCA) for ischemia after a non-Q-wave acute myocardial infarction (AMI) was assessed prospectively in 33 consecutive patients. In 30 patients the indication for the procedure was post-AMI angina and 3 patients underwent PTCA for silent ischemia. A total of 43 lesions were attempted at 63 +/- 94 days after the non-Q-wave AMI. Primary PTCA success was obtained in 30 (91%) patients and no major complications occurred. Angiographic evaluation was performed either for symptoms or for protocol (7 +/- 1 months after PTCA) in 28 (93%) of the 30 patients with successful PTCA, but 2 patients (7%) who were asymptomatic refused the repeat angiogram. Twenty (71%) had no restenosis and 8 (29%) had restenosis. Of these, 5 patients with restenosis underwent a successful repeat PTCA (6 +/- 1 months after the initial procedure). At the last clinical follow-up (17 +/- 8 months), 2 of the 30 (7%) patients successfully dilated presented with stable angina despite medical treatment, whereas the rest (93%) remained asymptomatic. During the study period no patient died, had an AMI or required coronary artery bypass grafting. Thus, selected patients with ischemia after a non-Q-wave AMI, a "high-risk population," can be effectively treated with PTCA with an initial success rate and angiographic restenosis rate similar to that of the general PTCA population and appear to have sustained symptomatic benefit remaining free of subsequent cardiac events.     

Doppler echocardiographic evaluation of left ventricular diastolic function after percutaneous transluminal coronary angioplasty for unstable angina pectoris or acute myocardial infarction

The effect of percutaneous transluminal coronary angioplasty (PTCA) on left ventricular (LV) diastolic function has not been systematically investigated in patients treated for unstable angina or ischemia after acute myocardial infarction (AMI). To assess the relation between reduction of stenosis severity and improvement in diastolic function in this setting, 42 patients with either unstable angina (n = 22) or post-AMI ischemia (n = 20) were serially monitored by Doppler echocardiography 8 +/- 5 hours before and 2 +/- 1 days after PTCA. Doppler LV filling indexes included isovolumic relaxation time, mitral deceleration time, E/A peak velocity ratio and atrial filling fraction. Eighteen aged-matched control subjects served to establish normal values for comparison. Before PTCA, both groups exhibited abnormal diastolic function demonstrated by prolonged isovolumic relaxation time and mitral deceleration time, decreased E/A ratio and increased atrial filling fraction. After PTCA isovolumic relaxation time and deceleration time decreased 18 +/- 28 (p less than 0.005) and 33 +/- 43 ms (p less than 0.002) in the unstable angina group and 18 +/- 23 (p less than 0.003) and 14 +/- 34 ms (difference not significant), respectively, in the post-AMI ischemia group. An increase in E/A ratio and a decrease in atrial filling fraction occurred in both groups; however, these changes were significant only in patients with post-AMI ischemia (+21%, p less than 0.03 and -11.4%, p less than 0.005, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)     

不稳定性心绞痛病人的介入治疗及随访

目的　观察 18例不稳定性心绞痛病人的经皮冠状动脉内成形术 (PTCA)后的即刻疗效及随访结果。方法　 18例不稳定心绞痛病人中 15例内科药物治疗平稳后二周行冠脉造影及PTCA ,3例因内科药物治疗效果不佳而行紧急的PTCA。成功 17例 ;病变共 33处 ,2 3处被治疗 ,置入支架 18支。结果　术后所有病人心绞痛症状缓解。术后随访平均 9个月 ,病人心功能 ,运动耐量 ,心律失常等均有明显改善。 14例病人心绞痛症状基本消失。 3例病人有心绞痛发作 ,但药物可以控制。 1例病人前降支完全闭塞导丝未能通过病变处而失败。 17例中无一例发生心肌梗塞或猝死。结论　不稳定心绞痛病人尽早进行冠脉造影及PTCA治疗是有必要的 ,成功率是高的     

Contraindications for percutaneous transluminal coronary angioplasty in treatment of unstable angina pectoris

In recent years, the indications for percutaneous transluminal coronary angioplasty have expanded to include multivessel disease, unstable angina pectoris, stenosis of coronary bypass grafts, and recent total coronary occlusion. To evaluate our experience in using percutaneous transluminal coronary angioplasty to treat unstable angina, we reviewed the records of the patients who underwent this procedure at our hospital between January 1983 and December 1986. Of the 689 patients who underwent balloon angioplasty during the study period, 454 had stable angina and 235 had unstable angina; of the latter group, 34 (14.5%) required emergency coronary artery bypass grafting after balloon angioplasty failed. This outcome was associated with 2 risk factors: previous myocardial infarction and triple-vessel disease. Our data suggest that, in cases of unstable angina pectoris, percutaneous transluminal coronary angioplasty should be reserved for patients with single-vessel disease and no evidence of previous myocardial infarction. They also lend credence to the conclusion that the disease process in unstable angina is different from that in stable angina, and that therapy should be directed towards reducing platelet aggregation and correcting global ischemia, rather than towards balloon angioplasty of "culprit lesions."     

Usefulness of hyperbaric oxygen therapy to inhibit restenosis after percutaneous coronary intervention for acute myocardial infarction or unstable angina pectoris

The purpose of this trial was to assess whether the addition of hyperbaric oxygen to percutaneous coronary intervention can reduce clinical restenosis. Major adverse cardiac events at 8 months were found in only 1 of 24 patients (4%) who received hyperbaric oxygen compared with 13 of 37 patients (35%) who did not.     

Emergency percutaneous transluminal coronary angioplasty for acute myocardial infarction

Coronary angioplasty combined with thrombolytic therapy using urokinase (UK-PTCA) was attempted for acute myocardial infarction from September 1983 to December 1985, and without thrombolytic therapy (direct PTCA), thereafter. For UK-PTCA, the lesion was severely stenosed in 13, subtotally occluded in two and totally occluded in 21, and 29 lesions (81%) were successfully dilated. For direct PTCA, the lesion was stenosed in five, subtotally occluded in two and totally occluded in 14, and 19 lesions (90%) were dilated. Only one lesion in UK-PTCA had restenosis during hospitalization, but it was successfully redilated. Follow-up angiography was performed for 26 among 29 UK-PTCA cases and showed patency (diameter stenosis less than 50%) in 13, restenosis (less than 50%) in 12 and occlusion in one. Ten among 12 restenosed lesions were redilated and they were all patent at subsequent angiography. In 15 of 19 dilated lesions with direct PTCA, the lesion was patent in 10, and restenosed in five. Four of them were redilated and remained patent at subsequent angiography. Major complications occurred only in the UK-PTCA group before the judicious use of intra-aortic balloon pumping for hemodynamic instability. These included two deaths due to cardiogenic shock, one coronary dissection, and one sudden reocclusion, possibly due to thrombus formation. PTCA is applicable with or without thrombolytic therapy for acute myocardial infarction with high primary success rate and maintain coronary flow thereafter.     

Success and complication rates of coronary angioplasty in the unstable angina pectoris stage after myocardial infarct--a comparison with percutaneous transluminal coronary angioplasty in the acute infarct stage and unstable angina pectoris without preceding myocardial infarct

To evaluate whether there is a difference in terms of the success and complication rates of PTCA in patients (pts) with unstable angina pectoris (UAP) after myocardial infarction (group I) and patients with myocardial infarction (group II), as well as in patients with UAP without preceding myocardial infarction (group III), we analyzed the data of 188 patients retrospectively. Acute PTCA was performed in 42 patients of group I, 55 patients of group II, and 91 patients of group III. The primary success rate was comparable in all three groups (group I: 74%; group II: 76%; group III: 77%). The incidence of acute ACVB operation was comparable in group I (5 pts: 9%) and group III (10 pts: 11%). One patient was operated during an acute myocardial infarction. Five patients of group I (9%) and seven patients of group III (8%) developed a myocardial infarction. Three patients of group I (7%) and three patients of group II (5%) died during hospitalization. PTCA performed during acute myocardial ischemia has the highest complication rate in patients with UAP after myocardial infarction and is considerably higher than in patients with UAP without preceding infarction.     

Identifying patients at high risk for restenosis after percutaneous transluminal coronary angioplasty for unstable angina pectoris

To study the determinants of late restenosis after percutaneous transluminal coronary angioplasty (PTCA) performed in patients with unstable angina pectoris, a prospective study was undertaken in 90 patients. Primary PTCA success was achieved in 84 (93%) patients, dilating 116 of 118 coronary narrowings (1.4/patient), while major complications during PTCA occurred in only 1 patient (1 death). Eighty-two patients (114 dilated arteries) were followed for 25 +/- 11 months: 68 (83%) were in New York Heart Association functional class I or II, 11 (13%) in class III, and there were 3 deaths. Late restenosis was found in 16 (25%) of 65 lesions (29% of 49 patients) studied by angiography 9 +/- 7 months after PTCA. Restenosis was more frequent in left anterior descending coronary artery lesions (p = 0.07) and in those which at the time of PTCA had multiple irregularities (67 vs 14%, odds ratio 12.5, p = 0.002), decreased coronary perfusion (Thrombolysis in Myocardial Infarction grade less than 3) (50 vs 15%, odds ratio 5.7, p = 0.02) or intraluminal thrombus (67 vs 19%, odds ratio 8.7, difference not significant). Multiple irregularities (p = 0.003) and decreased flow (p = 0.02) remained independent predictors of restenosis (goodness of fit 0.88) after adjustment for 12 pre- and peri-PTCA clinical and angiographic variables by logistic regression analysis. These data underline the feasibility of early revascularization by PTCA in patients with unstable angina pectoris. Careful follow-up should be instituted in patients with multiple irregular lesions, decreased coronary perfusion or intraluminal thrombus at the time of PTCA. In such patients, late restenosis may be the rule rather than the exception.     

补救性经皮冠状动脉腔内成形术治疗急性心肌梗塞

目的探讨补救性经皮冠状动脉腔内成形术（ＰＴＣＡ）在治疗急性心肌梗塞（ＡＭＩ）中的作用。方法对溶栓治疗失败的３６例患者进行补救性ＰＴＣＡ治疗。患者心功能Ｋｉｌｐ分级：Ⅲ级和Ⅳ级４例，Ⅱ级和Ⅰ级３２例。冠状动脉造影显示梗塞相关动脉：前降支１７例，右冠状动脉１４例，回旋支４例，中间动脉１例。ＰＴＣＡ前ＴＩＭＩⅠ级和Ⅰ～Ⅱ级血流各２例，余３２例均为ＴＩＭＩ０级。３６例均进行ＰＴＣＡ治疗，其中１３例患者置入了支架。结果术中除３例失败外，３１例患者病变血管血流达到ＴＩＭＩⅢ级，２例ＴＩＭＩⅡⅢ级，残余狭窄≤５０％，成功率为９１．７％。院内并发症：１例在ＰＴＣＡ成功后当天因顽固性休克和心室纤颤死亡；１例于第３天死于心脏破裂，住院病死率为５．６％。１４例患者在术后１～２个月内复查冠状动脉造影，２例发生再狭窄。结论ＡＭＩ患者在溶栓治疗失败后，在有条件的医院可施行补救性ＰＴＣＡ治疗，成功率高，对改善患者的近期和远期预后可能有利     

Results of using percutaneous transluminal coronary angioplasty in patients with stable and unstable angina pectoris and acute myocardial infarct

Transcutaneous transluminal coronary angioplastics (TTCA) was performed in 28 coronary heart disease patients (8 patients had stable and 5 others labile angina, 15 presented acute myocardial infarction, AMI). The patients with AMI received intracoronary thrombolytic treatment prior to TTCA. Successful dilatation was performed in one patient with narrowing of the main trunk of the left coronary artery, in 14 of 21 patients with the stenosis of the anterior interventricular branch and in 5 of 6 patients with the narrowing of the right coronary artery. In three cases TTCA was carried out in the presence of the occluded coronary artery, with two patients benefiting from the operation. In 5 patients with AMI in whom an attempt to dilate the lumen of the coronary artery was unsuccessful, emergency surgery for aorto-coronary shunting was conducted. This operation was also performed in the planned order in 2 angina patients. In 7 patients the failure of TTCA was explained by the impossibility to pass the dilatary sound through the stenosis of the coronary artery and in 1 case by the failure to enter the ostium of the left coronary artery with the guiding catheter.     

Clinical success after percutaneous transluminal coronary angioplasty failure for unstable angina

We report a patient who had an asymptomatic total occlusion of a left anterior descending coronary artery after PTCA for unstable angina. A clinical success with a negative maximal exercise test and absence of symptoms after PTCA can not be presumed to correlate with coronary patency.     

Treatment of unstable angina pectoris with percutaneous transluminal coronary angioplasty (PTCA)

Percutaneous transluminal coronary angioplasty (PTCA) was performed in 40 patients (34 male, 6 female; 51.0 +/- 8.5 years) with the typical clinical picture of unstable angina. All had a short history of pain (2.9 +/- 2.0 months), angina at rest, transient ST and/or T wave changes during this period, and little or no enzyme elevations. The patients had a total of 41 stenoses (39 single, one double; one main-stem, 26 left anterior descending, 14 right coronary artery). The degree of the stenoses was 95.5 +/- 4.9% (area method) and 81.8 +/- 10.7% (diameter method). PTCA was successfully performed in 26 cases (63%), reducing the stenoses to 61.5 +/- 12.4% (area method) and 39.1 +/- 10.0% (diameter method). One patient (2.5%) received an immediate bypass operation because of an acute vessel occlusion. Eleven of the 14 not successfully treated patients received an aortocoronary bypass within the next three to 35 days. All still had symptoms of unstable angina. Three patients refused operation. Their treatment consisted of nitroglycerin, beta-blockers and nifedipin. Seventeen of the 26 successfully treated patients were restudied after 4.9 +/- 1.7 months. The degree of stenosis had risen to 69.2 +/- 17.4% (area method). While the stenoses in 12 patients were equal or less than before PTCA, stenosis recurred in five cases. Two patients were successfully retreated. PTCA can be performed with a good early success rate and a low concentration rate in patients with unstable angina. Relief of pain and improvement of blood supply to the jeopardized myocardium can be provided immediately and with a limited amount of expense. The method can therefore be regarded first-stage treatment in such patients.     

Long-term follow-up after direct percutaneous transluminal coronary angioplasty for acute myocardial infarction

Objectives. The purpose of this study was to analyze long-term follow-up information over several years from consecutive, unselected patients treated with direct percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (MI).Background. Direct PTCA is often used in patients with acute MI. Short-term results are favorable. However, there is less information available on long-term observations over several years in these patients.Methods. A total of 416 consecutive and unselected patients with acute MI underwent direct PTCA. Survival of the acute infarct phase was 94.2%; the remaining 392 patients—the study population—were discharged and followed for 3.3 ± 1.4 years. Mortality as well as cardiac events and reinterventions are reported. Clinical variables assessed at the time of discharge are submitted to statistical analysis to detect potential risk factors.Results. Total cumulative mortality in the first year was 10% for the entire group and 6% for patients not presenting in cardiogenic shock. Mortality after discharge was 4.6% in the first year and dropped to <4% per year thereafter. Reinterventions after discharge were required in 16% in the first year and in <4% per year in years 2 to 4. Poor left ventricular ejection fraction (<35%), three-vessel disease and advanced age (≥75 years) were long-term risk factors for total mortality after direct PTCA.Conclusions. The clinical benefit of direct PTCA for acute MI is maintained during follow-up with respect to mortality. However, reinterventions for restenosis or de novo stenosis are often required (10% to 20%). Although few in number (<10%), patients with severely impaired left ventricular function continue to have a poor prognosis.     

Treatment of angina pectoris by percutaneous transluminal coronary angioplasty

Percutaneous transluminal coronary angioplasty (PTCA) was performed on 12 patients with angina pectoris. PTCA reduced the percentage of stenosis of the coronary artery from 75.6 +/- 10.1 (means +/- SD) to 32.6 +/- 19.5. In addition, anginal attacks per week was reduced from 8.4 +/- 3.2 to 2.5 +/- 0.7. No life-threatening complications were produced by PTCA. The results indicates the effectiveness of PTCA as a treatment for angina pectoris.     

Percutaneous transluminal coronary angioplasty for patients with unstable angina pectoris.

Percutaneous transluminal coronary angioplasty (PTCA) was successful in 91% of 76 patients with unstable angina pectoris refractory to pharmacological treatment. However, the rate of acute occlusion and reocclusion was rather high (95). Restenosis developed in 56.5% of successful cases after initial PTCA, and 29 patients underwent 2nd, and nine 3rd PTCA. Most refractory unstable angina can be controlled by PTCA, which may require repeating in some patients.