post-MI Angina Research Articles

Abstract 3584: The Prevalence and Factors Associated With 1-Year Angina among Post-MI Patients

Background: A primary goal of in-hospital treatment and outpatient care following myocardial infarction (MI) is the eradication of angina. However, the prevalence of angina and the factors associated with angina in the year after MI are unknown. Methods: The primary outcome of the PREMIER multi-center prospective study was presence of angina, as measured by the Seattle Angina Questionnaire (SAQ), 1 year after MI hospitalization. Multivariable regression modeling identified the socio-demographic factors, clinical history, MI presentation, inpatient therapies and complications, and outpatient treatment characteristics associated with 1-year angina, adjusted for site. . Results: Of 1957 patients in the cohort, 83 patients (4.2%) reported daily or weekly angina, and 306 patients (15.6%) reported less than weekly angina 1 year after their index MI. After multivariable analysis (figure ), angina 1 year after an index MI was associated with younger age, non-white race, baseline angina, history of CABG surgery, no inpatient revascularization, recurrent rest angina during MI hospitalization, persistent smoking after MI hospitalization, outpatient revascularization after MI hospitalization, and depressive symptoms (either as an inpatient or during the year after MI hospitalization). Conclusions: Angina 1 year after MI hospitalization is associated with several modifiable factors, including persistent smoking and depressive symptoms in the year after MI discharge. Recognition of these relationships will be important in monitoring and treating at-risk patients for post-MI angina.

Abstract 3586: Alcohol Consumption and One-Year Angina Risk After Myocardial Infarction

Background: Prior studies show light to moderate alcohol use is associated with reduced mortality and cardiovascular events, whereas heavy use increases mortality and cardiovascular risks. The association of alcohol use and post-myocardial infarction (MI) symptoms is unknown. We explored the association between alcohol use and risk of having angina 1 year after an MI. Methods: Upon enrollment in the 19-center prospective PREMIER registry, acute MI patients (n=2481) were asked about alcohol use. Angina (any vs. none) was assessed at 1 year with the Seattle Angina Questionnaire. The association of alcohol use and 1-year angina was modeled using a hierarchical multivariable modified Poisson regression model. Results: Overall, 47% reported never drinking and others reported having the following # of drinks/day: 42% < 1; 6% 1 to 2; 3% > 2 to 4; 2% > 4. After adjusting for demographic, clinical, and treatment variables, patients that reported never drinking were 45% more likely to have angina than moderate drinkers (1 to 2 drinks/day). However, > drinks/day was associated with an 81% greater risk of angina than moderate alcohol use. Those drinking < 1 drink/day or > 2 to 4 per day had similar angina risk compared to moderate drinkers. Results did not vary by gender (p > .05 for interaction). Conclusions: This study extends prior evidence of a dose-dependent relationship between alcohol use and other cardiovascular benefits/risks to post-MI angina. Moderate alcohol consumption (1 to 2 drinks/day) was associated with reduced risk of angina 1 year after MI compared to abstinence or heavy alcohol consumption. Excessive alcohol use (>4 drinks/day) was associated with increased risk of angina.

Beneficial effects of angiotensin-converting enzyme inhibitor and nitrate association on left ventricular remodeling in patients with large acute myocardial infarction: the delapril remodeling after acute myocardial infarction (DRAMI) trial

Background In the large-scale trial, Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico-3 (GISSI-3), patients receiving the combination of lisinopril and glyceryl trinitrate benefited most from experimental therapy. Therefore, a multicenter, randomized, double-blind study, Delapril Remodeling After Acute Myocardial Infarction (DRAMI), was designed to assess (1) the possible additive beneficial effect on left ventricular remodeling of nitrates when combined with an angiotensin-converting enzyme inhibitor (ACEI), and (2) the tolerability of a new ACEI, delapril, in respect to lisinopril in patients with large myocardial infarction (MI). Methods A total of 177 patients were randomized to receive delapril plus isosorbide-5-mononitrate (IS5MN) placebo, delapril plus IS5MN, lisinopril plus IS5MN placebo, or lisinopril plus IS5MN starting within the first 36 hours after the onset of symptoms and continuing for 3 months. Results More than 80% of the patients showed extensive ST-segment changes and 36.7% had signs or symptoms of heart failure during the first 36 hours. Over 3 months, IS5MN reduced, by 76%, the increase in LVEDV (17.4 ± 5.0 mL placebo vs 4.2 ± 4.4 mL IS5MN, P = .0439), reversed the increase in LVESV (7.5 ± 3.9 mL placebo vs −5.5 ± 2.9 mL IS5MN, P = .0052), and increased the recovery of LVEF (1.9% ± 1.3% placebo vs 6.7% ± 1.2% IS5MN, P = .0119). Overall, 3-month mortality was 10.2%; the most frequent clinical events were new episodes of severe heart failure (18.1%), persistent hypotension (10.7%), and post-MI angina (18.1%), with no differences between treatment groups. Conclusions Administration for 3 months of IS5MN combined with an ACEI, both started within 36 hours from the onset of symptoms, was safe and effective in reducing LV dilation and dysfunction after MI. The 2 ACEIs, delapril and lisinopril, appeared to be equally well tolerated.

Cardiac troponin I for risk stratification following percutaneous coronary artery intervention in acute coronary syndromes.

The cardiac troponins have been shown to provide prognostic information allowing risk stratification of patients with acute coronary syndromes (ACS). The benefit of early percutaneous coronary intervention (PCI) in this setting has been highlighted by the FRISC II study. We assessed the pattern of release of cardiac troponin I (cTnI) following PCI in patients with ACS and evaluated its prognostic value for major adverse cardiac events (MACE): death, Q-wave myocardial infarction (QWMI), and repeat revascularization at follow-up. cTnI was sampled at baseline and 6, 14, and 24 hr following PCI in 73 patients presenting with unstable and post-MI angina. Clinical follow-up was obtained in all 73 patients at a mean period of 43 +/- 19.9 weeks (range, 11-68 weeks). Patients were stratified into two groups according to whether cTnI remained unchanged or fell below baseline 24 hr post-PCI (group 1, n = 47) or increased above baseline 24 hr following PCI (group 2, n = 26). MACE occurred in 4 (8.5%) of patients in group 1 (QWMI = 1, CABG = 1, re-PCI = 2) and in 19 (73%) of patients in group 2 (death = 1, QWMI = 2, CABG = 2, re-PCI = 14; chi-square = 32.34, P < 0.0001). The positive predictive value of rising cTnI within 24 hr following PCI for MACE at follow-up was 0.73 and the negative predictive value was 0.92 (specificity = 83%, sensitivity = 86%; odds ratio = 29.18, 95% CI = 7.62-110.64, P < 0.0001). cTnI is an inexpensive and widely applicable tool that offers reliable prognostic information for the risk stratification of patients undergoing coronary revascularization in the setting of acute coronary syndromes and may identify a group of patients at particular risk of repeat PCI.

49-Year-Old Woman With Chest Pain

49-Year-Old Woman With Chest Pain

Coronary stent implantation without balloon predilatation: a single-center experience.

OBJECTIVE: Assessment of safety and efficacy of coronary stent deployment, without balloon predilatation. BACKGROUND: With newer high-performance balloon-premounted stents it has become more common to attempt coronary stent deployment without balloon pre- or postdilatation. METHODS: During 1998 524 coronary angioplasties were performed in the authors' institute, of which 279 resulted in coronary stenting. Of these 101 (36.2%) were stents without balloon predilatation (SWBP). PTCA was performed according to standard technique using mostly 7 F. guiding catheters, and 'rapid exchange' balloons and pre-mounted stents. RESULTS: Seventy-two patients had acute coronary syndromes (41 acute MI or post-MI angina, 28 unstable angina, 10 rescue PTCA after failed thrombolysis). Mean age was 56.4 3 11.1 years, 84.5% were males. Sixty per cent of the lesions were ACC-AHA type B2 or C. Target arteries were LAD 57.6%, LCX 21.2%, RCA 14.1% and SVG 7.1%. Procedure time was 18.2 3 17.3 minutes. Mean heparin dose was 3850 3 1570 units. Twenty-two patients received abciximab prior to stent deployment. Seven stents were not deployed without previous balloon dilatation and were retrieved safely via the guiding catheters and deployed after balloon dilatation. There was no stent embolization, ectopic suboptimal or partial stent deployment. Immediate angiographic success was obtained in 95 patients (94.1%). Minimal lumin diameter (MLD) increased from 0.27 3 0.15 to 3.23 3 2.1 mm. There were two in-hospital deaths (1.9%) due to cardiogenic shock. An intra-aortic balloon pump was required in eight patients. Two patients (1.9%) experienced subacute stent thrombosis. CONCLUSION: SWBP in selective groups of patients and lesions is feasible and safe. Larger randomized comparative trials are needed to assess the benefits and cost saving of this approach.

Acute coronary syndromes: unstable angina and non-Q-wave myocardial infarction.

Ischemic heart disease includes a wide spectrum of conditions, ranging from silent ischemia and exertion-induced angina, through unstable angina, to acute MI. Unstable angina occupies the center of this spectrum, causing disability and risk greater than that of chronic stable angina but less than that of acute MI1 (Fig 1⇓). Although non–Q-wave MI for many years was considered prognostically similar to unstable angina, recent longitudinal studies indicate that it is similar to Q-wave infarction2 3 (Fig 2⇓). Figure 1. Cumulative 6-month mortality from ischemic heart disease. Diagnosis on admission to hospital (n=21 761; 1985 to 1992). From Duke Cardiovascular Database. Reproduced with permission from Reference 1. Figure 2. Top, Cumulative 1-year combined death or MI among patients with Q-wave and non–Q-wave MI treated with fibrinolysis. Reproduced with permission from Reference 2. Bottom, Risk of subsequent cardiac events in stable convalescing patients after first non–Q-wave and Q-wave MI. Reproduced with permission from Reference 3. The concept of unstable angina has emerged from observations of frequent symptoms preceding acute MI, followed by prospective documentation that unstable symptoms frequently culminated in acute MI. The syndrome was rapidly accepted as a well-defined clinical entity as specific clinical manifestations, pathophysiological mechanisms, laboratory findings, and treatment became better characterized. Unstable angina is currently one of the leading causes of hospital admission for CAD, and non–Q-wave MI accounts for >30% of admissions for acute MI.1 4 Yet, the diagnosis of unstable angina remains clinical, based on symptom recognition. The physician caring for patients with unstable angina is in a privileged position of recognizing rapidly evolving CAD and being able to intervene to prevent irreversible left ventricular damage and progression of CAD. Unstable angina is classically described as a heterogeneous disease, referring to a wide spectrum of clinical manifestations from stable angina to MI, of disease …

Coronary angioscopic findings in the infarct-related vessel within 1 month of acute myocardial infarction: natural history and the effect of thrombolysis.

Limited angioscopic information is available on the natural history of infarct-related plaque after myocardial infarction (MI), in particular the effect of thrombolysis. We studied with angioscopy the morphological characteristics of the infarct-related lesion in 56 patients between 24 hours and 4 weeks after MI. Forty of these patients were initially treated with a thrombolytic agent. Most lesions were complex (complex + ulcerated shape = 54%). The predominant color of the plaque was yellow in 79% of cases; only 6% were uniformly white. Angioscopically visible thrombus was found in 77% of cases. Despite angioscopic evidence of instability, only 7% of the patients had post-MI angina. During the 1-month time window since the occurrence of MI, there was no significant difference in the angioscopic appearance of the plaque except for a slight increase in uniformly white plaques (P=.07). The use of a thrombolytic agent at the onset of MI was associated with a reduction in thrombus size and less protruding thrombi (P=.02) but not with a decreased frequency of plaque containing thrombi. Furthermore, a trend for more frequently ulcerated plaques (45% versus 16%, P=.06) was associated with the use of a thrombolytic agent. These results suggest that healing of the infarct-related lesion requires more than 1 month and that an "unstable" yellow plaque with adherent thrombus is common during that period. This finding may partly explain the unique behavior of recent infarct-related lesions, which are more prone to occlude than other lesions.

Frequency and Predictors of Major In-hospital Ischemic Complications After Planned and Unplanned New-Device Angioplasty From the New Approaches to Coronary Intervention (NACI) Registry

The purpose of this study was to determine the frequency and predictors of major in-hospital ischemic complications after planned and unplanned procedures with new angioplasty devices from the New Approaches to Coronary Intervention (NACI) registry. The NACI registry is a multicenter, voluntary reporting of consecutive patients undergoing new-device angioplasty procedures using atherectomy catheters, stents, or lasers. This registry affords the opportunity to evaluate the performance of new angioplasty devices during elective and urgent circumstances. The study population consisted of 3,340 patients with 3,733 lesions (2,921 in native coronary arteries and 812 in saphenous vein grafts [SVGs], who were treated with new devices over a 3.5-year period and had their angiograms analyzed independently at a central angiographic core laboratory. Their in-hospital course and multivariate predictors of the complications in planned and unplanned procedures, further divided into native and SVG lesions, were evaluated. In 82.2% of native coronary artery lesions and 96.9% of SVG lesions, the procedure with a device had been planned due to unfavorable lesion characteristics for PTCA. In the remaining lesions, device use was unplanned, and was performed mainly to treat a suboptimal result (59–80.4%) after percutaneous transluminal coronary angioplasty (PTCA), and less frequently after important complications of PTCA including abrupt closure and PTCA failure. In native artery cohort, major in-hospital ischemic complications (death, Q-wave myocardial infarction [MI], or emergency coronary artery bypass surgery) occurred in 2.7% of the planned and 9.9% of the unplanned procedures (p <0.001), whereas in SVG such complications occurred in 3.6% of the planned and 8.7% of unplanned procedures (p = 0.21). Multivariate analysis revealed several predictors of major ischemic complications from planned native coronary artery device use: post-MI angina (odds ratio = 2.83); severe concomitant noncardiac disease (odds ratio = 2.5); multivessel disease (odds ratio = 1.75); and de novo lesions (odds ratio = 2.3). Multivariate predictors of major complications in unplanned native coronary artery procedures included high surgical risk (odds ratio = 3.08), and tortuous lesion (odds ratio = 2.41). In SVG lesions, the independent predictors of major complications for planned procedures included age (odds ratio = 1.09), high surgical risk (odds ratio = 4.34), and thrombus (odds ratio = 2.62). In native and SVG lesions, rates of major complications of planned procedures was acceptable (2.7–3.67%), but unplanned use of a new device was associated with a significantly higher rate of in-hospital complications (≃9%). Multivariate predictors for major ischemic complications included both clinical and lesion characteristics, and differed for native versus SVG lesions, as well as for planned versus unplanned procedures.

Epidemiologic assessment of angina before and after myocardial infarction: The Framingham Study

Angina pectoris before and after MI was evaluated in a sample of 729 men and women from a general population in whom MI developed during a 36-year period of follow-up. Relations of AP to subsequent CHD events and mortality after initial MI were analyzed by proportional hazards regression models and were adjusted for covariates (age, sex, blood pressure, serum cholesterol, body mass index, glucose intolerance, cigarette smoking, and antihypertensive medications) obtained from routine biennial examinations preceding the initial MI. Comparisons of the influence of angina were made between pre-MI angina, post-MI angina, and absence of AP. The sample had 484 men and 245 women (mean ages, 63 and 69, respectively) who survived ≥30 days after MI. The initial MI was clinically unrecognized in 165 (34%) men and 115 (47%) women. Data on covariates were complete for 622 subjects, among whom 30% had pre-MI angina, 18% had post-MI angina, and 52% did not have AP. Angina was half as common in persons with unrecognized MIs as in those with clinically recognized MIs. During an average of 8.7 years of follow-up, 57% of subjects developed subsequent CHD events, including recognized and unrecognized MI, coronary insufficiency, and CHD death, and 74% died. Both pre-MI angina (hazard ratio, 1.49; 95% CI, 1.17 to 1.91) and post-MI angina (hazard ratio, 1.43; 95% CI, 1.06 to 1.94) adjusted for accompanying risk factors were associated with increased risk for subsequent CHD events compared with those without AP. Neither pre-MI nor post-MI angina was associated with excess overall mortality.

高齢者の心疾患 高齢者の急性心筋梗塞症と無症候性心筋虚血： 臨床像の特徴と冠動脈インターベンション時代における治療効果

To elucidate the clinical features of acute myocardial infarction (AMI) and post-MI silent myocardial ischemia (SMI) in the elderly, and efficacy of therapy in an era of coronary intervention, a total of 10,607 patients with AMI who were enrolled in a multicenter survey between 1982 and 1992 were examined. The elderly had a higher ratio of females, noncardiac illness, atypical symptoms at the onset of AMI, severe pump failure at admission, cardiac rupture and multivessel disease. Hospital mortality was markedly higher in patients > or = 75 years, and it was 4-fold compared with patients < 65 years. In the last 5 years, the rate of application of coronary angiography and primary PTCA significantly increased even in the very elderly. In contrast, use of thrombolysis highly diminished. Hospital mortality declined (14.6 vs 11.9%, p < 0.001) in every age group compared with the first 5 years, although it was higher in the elderly even in the last 5 years. Investigation of 642 survivors after AMI admitted to one hospital showed that the elderly had a higher incidence of SMI and post-MI angina compared with the non-elderly. Clinical features of SMI were similar in both groups. However, medical treatment was more prevalent and recurrence of MI and cardiac death during follow-up (average 27 months) were more frequent in the elderly. In this retrospective study, characteristics of AMI and SMI, and effectiveness and limitation of therapy in the elderly were clearly demonstrated. It was evident that hospital mortality of the elderly had improved, although it was still higher than the non-elderly.

802-4 Care of Acute Myocardial Infarction by Non-invasive and Invasive Cardiologists: Procedure Use, Cost, and Outcome

To determine if physician subspecialization influences practice style and resource utilization, we prospectively studied 292 consecutive emergency room admissions with MI under the care of noninvasive (NON, n = 213) or invasive (INV, n = 79) cardiologists and compared the use of cardiac procedures, cost, and outcome. Patient age, gender, CAD risk factors, history of angina, MI, CHF, and prior cardiac catheterization, PTCA or CABG were comparable. Presentation of MI. non-O/Q-wave MI, use of thrombolytic therapy, peak CK, and EF did not differ. Procedures, cost, and length of stay were as follows: NON INV p-value Thall Ett (%) 45 36 NS Catheterization (%) 59 67 NS CABG (all pts, %) 13 12 NS PTCA (3VD, %) 17 35 NS PTCA (1 or 2-VD, %) 39 60 &lt; 0.05 Total hospital days 14 17 &lt; 0.05 ICU days 31 5.4 &lt; 0.01 Hospital costs ($) 19,400 25,500 0.01 There were no differences between groups in the incidence of postMI complications (shock, pulmonary edema, post-MI angina, VT/VF) or reversible thallium perfusion defects. Overall, 61% of patients underwent cardiac catheterization; there were an equal number of patients with 1, 2, and 3-vessel CAD in each group. Multivariate predictors of PTCA in patients with 1 or 2-vessel CAD were previous PTCA, Q-wave MI, and care by INV. In-hospital reinfarction and mortality (8.7% vs 12.7%) did not differ; during median 12-month follow-up (96% of pts), reinfarction and mortality (11.3% vs 10.3%) were similar, In this pilot study, subspecialization impacted upon the cost of care of MI and led to increased PTCA in patients with 1 or 2-vessel CAD; larger studies are needed to determine the influence of subspecialization on long-term clinical outcomes.

Differentiation of myocardial ischemia and left ventricular aneurysm in the genesis of exercise-induced ST-T changes in previous anterior myocardial infarction.

We attempted to differentiate between myocardial ischemia and left ventricular asynergy as the underlying mechanisms of exercise-induced ST-segment elevation in patients with previous myocardial infarction (MI). Sixty patients with previous anterior MI, who underwent stress myocardial scintigraphy (SMS) and coronary angiography (CAG), which revealed a single vessel disease of the left anterior descending artery, were entered in this study. SMS and CAG were performed within 3 months of MI onset, and SMS and ECG were quantitatively analyzed. T wave changes to a complete upright position with concomitant ST-segment elevation (T-dominant ST-elevation) was seen in 56% of the patients with post-MI angina pectoris (N = 16) and in 50% of those with significant redistribution in SMS (n = 20). On the other hand, ST-segment elevation without T wave reversion (ST-dominant ST-elevation) was seen in 43% of patients with severe LV asynergy (akinesis and dyskinesis, n = 39) and in 50% of those with severe scintigraphic defect in delayed images (relative thallium uptake less than or equal to 40%, n = 10). When these findings were combined, T-dominant ST-elevation had sensitivity and specificity of 54% and 78%, respectively, for the diagnosis of myocardial ischemia, while the corresponding values for ST-dominant ST-elevation were 44% and 100%, for the diagnosis of severe ventricular asynergy. We conclude that the two underlying mechanisms, ischemia and asynergy, may produce different changes in ST-T shape in patients with previous myocardial infarction.

Effectiveness and limitation of the current coronary care unit in treatment of patients with complications following acute myocardial infarction.

For an appraisal of effectiveness and limitation of the current coronary care unit (CCU) in treatment of patients with complications following acute myocardial infarction (MI), consecutive 557 patients hospitalized to our CCU during five years were studied. In order to assess the severity of complicating pump failure, patients were divided into four classes according to Killip's classification. Number of patients, total mortality (%) and mortality due to pump failure (%) were as follows; 333 (6%, 2%) in class I, 118 (17%, 8%) in class II, 42 (19%, 17%) in class III and 55 (84%, 80%) in class IV. Warning arrhythmias, cardiac rupture and interventricular septal perforation complicated in 184 patients, 11 and 10, respectively, and mortality due to these complications was 2%, 91% and 84% in the order. Right ventricular infarction complicated in 54 patients, but only one patient died from right heart failure. Post-MI angina manifested in 156 patients and six of them died postoperatively. Our data indicate that improvement in mortality due to pulmonary edema and arrhythmias and reduction in incidence of cardiac rupture are evident effectiveness of the CCU, and that there is no improvement in survival rate of patients with cardiogenic shock even under the use of newly introduced vasodilator and catecholamine therapy or intraaortic balloon pumping.

Percutaneous Coronary Intervention in Chronic Total Occlusion - In Hospital Outcome

Background- Although a total coronary occlusion is identified approximately in one third of the diagnostic cardiac catheterizations, still an attempted revascularization of total occlusion accounts for less than 8% of all percutaneous coronary interventions (PCI). Percutaneous Coronary Intervention (PCI) of chronic total occlusion (CTO) is one of the major challenges in interventional cardiology. It is now an well-accepted revascularization procedure. Methods: It was a prospective observational study conducted in National Institute of Cardiovascular Diseases, Dhaka, from July 2004 to June 2005. 50 consecutive patients with chronic total occlusion undergoing PCI were included in the study. Patients were observed during procedure and during the hospital stay. Result: The mean age of the patients was 46.7 ± 9.3 and 48.0% were in the age range of 45-54 years. 24 patients had post MI angina, 20 patients had chronic stable angina and 6 patients had unstable angina. Technical success was in 98% cases and procedural success was in 94% cases. One patient developed vessel perforation and was treated by prolonged balloon inflation. There was no death or STEMI and only 2 patients developed NSTEMI. Conclusion: In our study with the use of available facilities PCI in CTOs was possible with a high success rate. But dealing of more complicated lesion will require more improved technology and hardware. A study with larger number of patients and longer duration of follow up to determine the efficacy of the procedure in improving morbidity and mortality is needed. Keywords : Chronic total occlusion; Percutaneous Coronary Intervention; In hospital outcome DOI: http://dx.doi.org/10.3329/cardio.v1i2.8122 Cardiovasc. j. 2009; 1(2) : 156-160

Immediate Clinical Outcome of 600 Cases of Percutaneous Coronary Intervention (PCI)

This is an ongoing study done in National Institute of Cardiovascular Diseases (NICVD) during the period April 2002 to October 2007, few cases were done in Eurobangla Heart Hospital, Lab Aid Cardiac Hospital &amp; National Heart Foundation, SSMC &amp; MH, Metropolitan Medical Center. Total number of study population was 600 with male 550 &amp; female 50. Indication of Percutaneous coronary intervention (PCI) was- Unstable angina (with no prior myocardial infarction) 240 cases, MI inferior (with post Myocardial infarction angina) 204 cases &amp; MI anterior (with post MI angina) 156 cases. The risk factors were Hypertension (HTN) 310 cases (52%), smoking 426 cases (71%), Diabetes Mellitus (DM) 180 cases (30%), Positive family history for ischemic heart diseases (IHD) 120 cases (20%), Hyperlipidemia 150 cases (25%). Total number of target coronary arteries was 760 and total number of lesion was 803 of which780 lesions treated. Distribution of 803 lesions were left anterior descending coronary artery (LAD) 389 (proximal LAD 152, mid LAD 177, distal LAD 60), Right coronary artery (RCA) 230 (proximal 94, mid RCA 93, Distal RCA 26, RCA PD 17), Left circumflex coronary artery (LCX) 137 (proximal LCX 60, mid LCX 54, distal LCX 16, LCX PD 07), diagonal 15, obtuse marginal (OM) 20, ramus intermedius. Angiographic diagnosis of the patients were Single vessel disease 312 (52%), Double vessel disease 156 (26%) &amp; Triple vessel disease 132 (22%). Number of lesions treated were 803 of which 780 lesions was treated. PTCA with stenting done in 725 lesion &amp; 34 lesions treated with plain PTCA. Total occlusion was treated in 85 cases. The native vessel has a mean reference diameter was 3.03 ± 0.61 mm. Residual stenosis after deploying stents was &lt;10%. Our success rate was-angiographic success 96%, procedural success 94% &amp; clinical success 92%. Total mortality was 03. One patient having triple vessel disease died on P the procedure due to sudden cardiac arrest due to asystole, one pt died on the table due to acute closure by thrombus &amp; one patient died on 4th day due to huge retroperitoneal hemorrhage &amp; shock. Sub acute stent thrombosis occurs in 3 cases causing acute myocardial infarction &amp; one case required emergency CABG. Following procedure, in hospital course of the patients were uneventful. All the patients were discharged by three to fourth day of the procedure with improvement of their clinical condition. So the result of our study is good both in plain PTCA group &amp; PTCA + stent group. &#x0D; &#x0D; (University Heart Journal 2007; 3 : 50-56)