Percutaneous transluminal coronary angioplasty (PTCA) in patients with relative contraindications: Results of the national heart, lung, and blood institute PTCA registry

Abstract

The effects of relative contraindications on the immediate results of PTCA were investigated in 1,939 patients, and on long-term results in 998 patients with isolated stenosis of 1 coronary artery. Immediate results subjected to analysis were: success rate, major complications (coronary occlusion, MI and death) and emergency CABG. The analysis of long-term results included: status of angina pectoris, occurrence of MI, restenosis, repeat PTCA, CABG and death. Unstable angina and previous MI had no negative effects on immediate results, whereas a significantly lower success rate was noted in patients with angina for more than 1 year compared to patients with angina of shorter duration (p < 0.05) and patients older than 60 years compared with younger patients (p < 0.01). During follow-up, patients with unstable angina had higher CABG rate (p < 0.01); the other relative clinical contraindications to PTCA did not exert adverse effects. Angiographically, there was a lower immediate success rate in patients with nonproximal stenosis (p < 0.001) and in patients with calcium in the affected artery (p < 0.01) and at the site of stenosis (p < 0.001). Patients with tubular or diffuse stenoses had similar success rates but higher rates of complications, excluding death, than those with discrete stenoses (p < 0.01). Patients with eccentric stenoses had a lower success rate and a higher rate of complications and emergency CABG than patients with concentric stenoses (p < 0.001 for all 3 variables). Coronary spasm during diagnostic angiography did not adversely affect the immediate results. Finally, patients with an ejection fraction of less than 50 % had a similar success rate but higher rate of complications, including death, than patients with a higher ejection fraction (p < 0.01), and underwent repeat PTCA more often (p < 0.05) during follow-up. None of the other angiographic relative contraindications had unfavorable effects on long-term results of PTCA. The study suggests that the present guidelines for PTCA eligibility are somewhat restrictive. However, the individual cardiologist should relax the guidelines cautiously and gradually, and only after reaching the plateau of his learning curve.