Long term result of revascularization after angioplasty

Should we ‘randomize’?
  • P. W. Serruys
  • B. J. Meester
  • P. J. De Feyter
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 113)


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 [1] 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%.


Coronary Angioplasty Multivessel Disease Single Vessel Disease Incomplete Revascularization Procedure Related Major Complication 
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  1. Detre K, Holubkov R, Kelsey S, Cowley M, Kent K, Williams D, Myler R, Faxon D, Holmes D Jr, Bourassa M (1988) Percutaneous transluminal coronary angioplasty in 1985-1986 and 1977–1981. The National Heart, Lung and Blood Institute Registry. N Engl J Med 318 (5): 265–270.Google Scholar
  2. Ellis SG, Roubin GS, King III SB, Doublas JS Jr, Weintraub WS, Thomas RG, Cox WR (1988) Angiographic and clinical predictors of acute closure after native vessel coronary angioplasty. Circulation 77: 372–379.Google Scholar
  3. Ellis SG, Roubin GS, King III SB, Douglas JS Jr, Shaw RE, Stertzer SH, Myler RK (1988) In-Hospital Cardiac Mortality After Acute Closure After Coronary Angioplasty: Analysis of Risk Factors from 8,207 Procedures. J Am Coll Cardiol 11 (2): 211–216.Google Scholar
  4. Bertrand ME, Marco J, Cherrier F, Schmiff R, Gaspard Ph, Puel J, Valeix B, Bory M, Crochet H, Berland R, Machecourt J, Foucault JP, Bassand JP, Bourdonnec CL, Quirck A, Jault F. (1986) French percutaneous transluminal coronary angioplasty (PTCA) registry: Four years experience. J Am Coll Cardiol 1 (2): 21 A.Google Scholar
  5. Serruys PW, Luijten HE, Beatt KJ, Geuskens R, Feyter PJ de, Brand M van den, Reiber JHC, Katen HJ ten, Es GA van, Hugenholtz PG (1988) Incidence of restenosis after successful coronary angioplasty: A time-related phenomenon. Circulation 77: 361–371.PubMedCrossRefGoogle Scholar
  6. Vandormael MG, Deligonul U, Kern MJ, Harper M, Presant S, Gibson P, Galan K, Chait- man BR (1987) Multilesion coronary angioplasty: Clinical and angiographic follow-up. J Am Coll Cardiol 10 (2): 246–252.PubMedCrossRefGoogle Scholar
  7. Gruentzig AR, King SB, Schlumpf M, Siegenthaler W (1987) Long-term follow-up after percutaneous transluminal coronary angioplasty. The early Zurich experience. N Engl J Med 316 (18): 1127–1132.PubMedCrossRefGoogle Scholar
  8. Kamp O, Serruys PW, Feyter PJ de, Brand M van den, Suryapranata H, Domburg R van (1987) Medium and long term follow-up (F/U) after PTCA for stable and unstable angina (AP).Eur Heart J(8)3: 1029.Google Scholar
  9. 9.
    Feyter PJ de, Suryapranata H, Serruys PW, Beatt K, van Domburg R, Brand M van den, Tijssen JJ, Azar AJ, Hugenholtz PG (1988) Coronary Angioplasty for Unstable Angina: Immediate and Late Results in 200 Consecutive Patients With Identification of Risk Factors for Unfavorable Early and Late Outcome. J Am Coll Cardiol 12 (2): 324–333.PubMedCrossRefGoogle Scholar
  10. Deligonul U, Vandormael MG, Kern MJ, Zelman R, Galan K, Chaitman BR (1988) Coronary Angioplasty. A Therapeutic Option for Symptomatic Patients with Two and Three Vessel Coronary Disease. J Am Coll Cardiol 11 (6): 1173–1179.PubMedCrossRefGoogle Scholar
  11. Griintzig AR (1978) Transluminal dilatation of coronary artery stenosis. Lancet 1: 263.CrossRefGoogle Scholar
  12. Mata LA, Bosch X, David PR, Rapold HJ, Corcos T, Bourassa MG (1985) Clinical and Angiographic Assessment 6 Months After Double Vessel Percutaneous Coronary Angioplasty. J Am Coll Cardiol 6 (6): 1239–1244.PubMedCrossRefGoogle Scholar
  13. Roubin G, Redd D, Leimgruber P, Abi-Mansour P, Tate J, Gruentzig A (1986) Restenosis after multi-lesion and multi-vessel coronary angioplasty (PTCA). J Am Coll Cardiol 1 (2): 22A.Google Scholar
  14. Myler, RK, Topol EJ, Shaw RE, Stertzer SH, Clark DA, Fishman J, Murphy MC (1987) Multiple vessel coronary angioplasty: Classification, results, and patterns of restenosis in 494 consecutive patients. Cathet Cardiovase Diagn 13 (1): 1–15.CrossRefGoogle Scholar
  15. Finci L, Meier B, Bruyne B De, Steffenino G, Divernois J, Rutishauser W (1987) Angiographic Follow-up after multivessel percutaneous transluminal coronary angioplasty. Am J Cardiol 60 (7): 467–470.PubMedCrossRefGoogle Scholar

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© Kluwer Academic Publishers 1991

Authors and Affiliations

  • P. W. Serruys
  • B. J. Meester
  • P. J. De Feyter

There are no affiliations available

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