Long term result of revascularization after angioplasty
Last year, on both sides of the Atlantic, we celebrated the tenth anniversary of the first coronary angioplasty performed in Zürich by Andreas Grüntzig. It is common place to say that many things have changed over the last ten years. Indeed, if we analyze the baseline data of the PTCA registry of the National Heart Lung and Blood Institute  and if we compare the patients enrolled between 1978 and 1982 with those treated in 1985–1986, then it becomes apparent that new PTCA cases have significantly higher incidence of previous CABG and previous MI than the early registry cases, 13% versus 9% and 37% versus 21%. (Table 1). The percentage of patients with multivessel disease has increased from 25% to 53% and are now more common than the single vessel disease. A much higher proportion of the current cohort have multiple lesion attempted, 40% versus 9% in the early registry. Despite generally sicker patients and more ambitious procedures, the rates of major inhospital events have decreased for the new registry cohort. The incidence of elective CABG has dropped dramatically from 20.7% to 2.2%. Similarly, the incidence of emergency CABG in the new cohort is 3.4% compared to 5.8%. The incidence of dissection and non fatal MI, as well as the death rate are almost identical for the old and new cohort. Complementing these lower rates of events and complications there are much higher rates of angiographic and overall success. In the new cohort, at least one dilatation per patient was successful in 91% of the cases compared to 68% in the earlier cases. Eighty-two percent of the new cohort had all attempted lesions successfully dilated compared to 65% of earlier PTCA cases. The overall success rate when all lesions are attempted is up significantly from 61% to 78% for new registry patients and the success per lesion has increased from 67% to 88%.
KeywordsCoronary Angioplasty Multivessel Disease Single Vessel Disease Incomplete Revascularization Procedure Related Major Complication
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