Long-term results of successful and failed angioplasty for chronic total coronary arterial occlusion

Abstract

The results over a mean period of 2 years of successful percutaneous transluminal coronary angioplasty (PTCA) in 100 consecutive patients with chronic total coronary occlusion were compared with those in 100 consecutive patients whose PTCA was unsuccessful. The groups were comparable in terms of gender, age and arteries attempted. A control angiography in the group with successful PTCA was performed in 62 patients and showed a restenosis in 28 (45%). Repeat PTCA was performed in 21 versus 1 patient with failed PTCA (p < 0.0001). At follow-up, in the group with successful PTCA, there were 57 symptom-free patients versus 26 patients in the group with failed PTCA (p < 0.0001). Coronary artery bypass surgery was performed in 7 versus 37 patients (p < 0.0001), and there were 5 versus 3 deaths (difference not significant), respectively. In the group with successful PTCA, 27 of 82 patients (33%) had positive stress test results, compared with 49 of 85 patients (58%) in the group with unsuccessful PTCA (p < 0.001). The double product (beats/ min × mm Hg/100) in patients with successful PTCA improved from 247 ± 57 before PTCA to 277 ± 61 (p < 0.001) at follow-up, whereas it did not significantly change in patients with failed PTCA. The work load (W) in patients with successful PTCA improved from 95 ± 34 before PTCA to 124 ± 40 at follow-up (p < 0.001). In patients with failed PTCA, work load improved less significantly, from 98 ± 37 before PTCA to 108 ± 34 at follow-up (p < 0.05). Thus, up to a mean of 2 years, patients with successful coronary angioplasty of chronic total coronary occlusion appeared to fare better than those whose angioplasty was unsuccessful.