Results Of PTCA Research Articles

Door to Balloon Time in St-Segment Elevation Myocardial Infarction (STEMI): A Prospective Study

Background: The most acute manifestation of coronary artery disease is ST-segment elevation myocardial infarction (STEMI) and is associated with mortality and morbidity. In the majority of cases, complete thrombotic occlusion develops from an atherosclerotic plaque in an epicardial coronary vessel is the cause of STEMI. Early diagnosis and immediate reperfusion reduce the risk of post-STEMI complications and heart failure and thereby are the most effective ways to limit myocardial ischemia and infarct size. If primary percutaneous coronary intervention (PCI) cannot be performed within 120 minutes of STEMI diagnosis, fibrinolysis therapy should be administered to dissolve the occluding thrombus and PCI has become the preferred reperfusion strategy in patients with STEMI.
 Methods: From the emergency section of the hospital in the month of October 2021, 7 adult patients were identified with ST-segment–elevation myocardial infarction undergoing primary percutaneous coronary. We used the framework of regression discontinuity to test for discontinuity at 90 minutes among the included cases. The Door - Balloon as 90 minutes minus the time between hospital arrival and catheterization laboratory arrival -defined as a novel variable. To assess the relationship between remaining Door - Balloon time and access site we have estimated multivariable logistic regression models.
 Results: The results of primary PTCA in the month of October 2021 were performed in less than 90 minutes without any mortality in 7 patients.
 Conclusions: Our Data on mortality and morbidity benefits of primary angioplasty shows a 100% decrease in mortality of patients undergoing primary PTCA within 90 minutes as compared to international data which shows a 40% decrease.

Clinical and Angiographic Results of Percutaneous Excimer Laser Versus Balloon Angioplasty for Coronary Intra-Stent Restenosis

Treatment of in-stent restenosis (ISR) with conventional PTCA causes significant recurrent neointimal tissue growth in 30-85% of the cases. Therefore, laser ablation of intra-stent neointimal hyperplasia prior to balloon dilatation can be an attractive alternative. However, the long-term outcomes of such treatment have not been studied thoroughly enough. This prospective case-control study evaluated angiographic and clinical outcomes of PTCA alone and a combination of excimer laser coronary angioplasty (ELCA) and adjunct PTCA in 125 patients with ISR. ELCA was performed prior to balloon dilatation in 67 patients, PTCA alone was performed in 58 patients. Basic demographic and clinical data were comparable in both groups. Lesions included in ELCA group were longer (17.1±9.9 mm versus 13.6±9.1 mm; p=0.034), more complex (36.5% type-C stenoses versus 14.3%; p=0.006) and more frequently had reduced distal blood flow (TIMI < 3: 18.9% versus 4.8%; p=0.025) compared to lesions in PTCA group. Immediate angiographic results of PTCA and ELCA+PTCA appeared to be comparable. PTCA alone was successful in 57 patients (98.3%), ELCA+PTCA - in 66 patients (98.5%). The rates of hospital complications were comparable (3.0% in ELCA group versus 8.6% in PTCA group). The 1 year-follow-up showed that the rates of MACE were comparable in the two groups (37.3% in ELCA group versus 46.6% in PTCA group). The rates of TVR within 1 year after the intervention were also similar in ELCA and PTCA groups (32.8% versus 34.5%). The data mean that ELCA in patients with complex ISR is efficient and safe. Despite a higher complexity of lesions in ELCA group, no increase in the rate of complications was registered.

Angiographic analysis of the angioplasty versus rotational atherectomy for the treatment of diffuse in-stent restenosis trial (ARTIST)

Patients with diffuse in-stent restenoses (ISRs) are at high risk for recurrent restenosis after percutaneous transluminal balloon angioplasty (PTCA). Percutaneous transluminal rotational ablation (PTCR) has proved effective in removing neointimal burden in ISRs. This study compares the acute and long-term results of PTCA and PTCR for the treatment of diffuse ISR in a randomized, multicenter investigation. The primary end point was the comparison of the minimum luminal diameter (MLD) between both groups at 6-month follow-up. Patients with symptomatic, diffuse, or high-grade ISRs were included; 146 patients were randomized to PTCA and 152 patients to PTCR. Diameter stenosis was reduced from 80 ± 12% to 29 ± 10% and from 80 ± 11% to 28 ± 12%, respectively, and MLD increased from 0.55 ± 0.3 to 1.9 ± 0.3 mm in the PTCA group and from 0.54 ± 0.3 mm to 1.9 ± 0.4 mm in the PTCR group. Spasm in the treated vessel and an intermittent slow flow phenomenon occurred more often after rotational ablation (17.7% vs 8.6%, p = 0.001; 5.3% vs 0%, p = 0.007). Minimum stenosis diameter at 6-month follow-up was smaller in the PTCR group than in the PTCA group (1.0 ± 0.6 vs 1.2 ± 0.6 mm, p = 0.008) and the restenosis rate was higher (64.9% vs 51.2%, p = 0.027). Procedural factors did not influence long-term outcome. In the PTCR group, the restenosis rate increased with decreasing vessel size, whereas this was not seen in the PTCA group. The lesion length and the baseline diameter stenosis were found to be predictive of restenosis with both treatment strategies; however, a residual diameter stenosis of <30% predicted absence of a restenosis only in the PTCR group. Thus, PTCA and PTCR of diffuse ISRs yield comparable acute angiographic results. The recurrence of a restenosis is higher after PTCR than after PTCA.

Reduced incidence of clinical restenosis with newer generation stents, stent oversizing, and high-pressure deployment: single-operator experience.

Over the last 4 years, several newer generation stents have become available, promising to change the scenery of coronary angioplasty (PTCA) with its attendant restenosis rate. The aim of this study was to review prospectively the results of a single operator adopting a uniform approach with approximately 0.5 mm stent oversizing and high-pressure (> or = 12-16 bar) deployment and compare them with conventional PTCA in a series of 244 consecutive patients. The study included 203 men and 41 women, aged 59 +/- 11 years, who presented with stable angina and/or positive exercise testing (n = 75), unstable angina (n = 161), or acute myocardial infarction (n = 8). Dilated vessels included the left anterior descending artery (n = 139), the right coronary artery (n = 86), the left circumflex artery (n = 47), the ramus branch (n = 4), or venous grafts (n = 2). Stents were implanted for dissection, suboptimal PTCA result, and electively. Two groups were compared: 83 patients who underwent balloon PTCA alone and 161 patients who also received stent(s). The two groups had similar demographics, age (58 +/- 10 vs. 59 +/- 11 years), initial vessel stenosis (92 +/- 7 vs. 93 +/- 6%), and left ventricular ejection fraction (51 +/- 9 vs. 51 +/- 8%). Procedural success was also similar (97.6 vs. 99.4%), but as expected the residual stenosis was much lower in the stent group (< or = 0 vs. 17%). The following stents were employed: J & J (n = 1), NIR (n = 117), ACS (n = 59), AVE (n = 9), Inflow GoldFlex (n = 9), Crossflex (n = 5), Wictor (n = 1), Jostent (n = 16), R stent (n = 9), Seaquence (n = 2) and Wallstent (n = 1). Single stents were used in 118 patients, two stents in 31 patients, three in 6 patients, and four in 6 patients. There was one in-hospital death at 3 days unrelated to the procedure. There were no events of subacute stent thrombosis; all patients in the stent group received combined therapy with aspirin and ticlopidine, the latter for 1 month. During 18 +/- 14 months, the clinical restenosis rate was significantly lower in the stent group (6.9%) than in the PTCA group (28.4%) (p = 0.001). In a series of 244 consecutive patients, newer generation stents and a consistent approach of stent oversizing and high-pressure stent deployment by a single operator resulted in high procedural success (99%), lack of stent thrombosis (0%), and a very low clinical restenosis rate (7%).

Ultrasound guidance: technique and results of aggressive ultrasound-guided PTCA. The UPSIZE Pilot Trial.

Stenting results in a larger lumen than conventional balloon angioplasty. This is the major determinant of a good acute and long-term result. In this non-randomised, single centre trial, intravascular ultrasound was used preinterventionally to guide the choice of the balloon size. The aim was to achieve a maximum lumen area with balloon angioplasty only. We included 346 patients with 360 lesions. The diameter of the external elastic lamina by intravascular ultrasound was 4.67 mm. A mean balloon size of 4.0 mm was chosen. The initial luminal gain was 1.82 mm, the lumen area post intervention was 6.6 mm(2). Dissections occurred frequently but the incidence of major adverse events was not increased. At one year follow-up, the overall event free survival was 81%. Target lesion revascularisation was performed in 34 patients (10%). An angiographic follow-up was available for 261 patients (76%). Restenosis (> 50% diameter Stenosis) was found in 21%. The results show, that ultrasound guidance of balloon angioplasty provides a means to achieve a large initial luminal gain without the routine use of stents. The acute and long-term results suggest that the approach is safe and efficient. The data compare favorably with similar studies using advanced intravascular diagnostic tools to guide the angioplasty procedure.

An introduction to provisional stenting

Provisional or conditional stenting should be defined as the use of stents limited to those conditions and cases in which the operator, despite an aggressive balloon angioplasty technique with large balloons and high pressure, has been unable to obtain a result that ensures optimal chances of early and late patency. The paramount issue is how to discriminate the patients with optimal results after balloon angioplasty for whom additional stent implantation is unlikely to improve or may even worsen long-term outcome. The better results of elective stent implantation in the OPUS study suggest that visual assessment of the PTCA result is not sufficient to detect lesions with suboptimal lumen gain after PTCA. The addition of physiologic parameters (Doppler flow velocity measurements, fractional flow reserve) has improved the results of the provisional stent group, with the best outcome observed when complex lesions and multivessel treatment were included in these studies (FROST, DESTINI). Intravascular ultrasound, although more expensive and time-consuming, has the additional advantage to guide the dilatation strategy.

The role of acute wall recoil and late restenosis: results of the OCBAS trial (Optimal Coronary Balloon Angioplasty with Provisional Stenting versus Primary Stent).

Early deterioration of minimal luminal diameter immediately after PTCA, has been associated with an increase of late restenosis. Lesions with no early loss after PTCA have a low restenosis rate. Coronary stents reduce restenosis in lesions exhibiting early wall recoil. The purpose of the OCBAS study was to compare two strategies during coronary interventions; provision vs. elective stenting. 116 patients with good PTCA results were randomized to stent (n = 57) or to optimal PTCA (n = 59). After randomization in PTCA group, 13.5% of the patients crossed over to stent due to early loss (provisional stenting). Baseline demographic and angiographic characteristics were similar in both groups of patients. At 7.6 months, 96.6% of the entire population had a follow-up angiographic study; 98.2% in the stent and 94.9% in the PTCA group. Immediate and follow-up angiographic data showed that acute gain was significantly higher in the stent than in the PTCA group (1.95 vs. 1.5 mm; P < 0.03). However, late loss was significantly higher in the stent than the PTCA groups (0.63 +/- 0.59 vs. 0.26 +/- 0.44, respectively; P = 0.01). Hence, net gain with both techniques was similar (1.32 +/- 0.3 vs. 1.24 +/- 0.29 mm for the stent and PTCA groups respectively; P = NS). Angiographic restenosis rate at follow-up (19.2% in stent vs. 16.4% in PTCA; P = NS) and TVR (17.5 in stent vs. 13.5% in PTCA; P = NS) were also similar. Furthermore, event-free survival was 80.8% in the stent versus 83.1% in the PTCA group (P = NS). Overall costs (hospital and follow-up) were US$591,740 in the stent versus US$398,480 in the PTCA group (P < 0.02). The strategy of the PTCA with delay angiogram and provisional stent if early loss occurs, had similar restenosis rate and TVR than universal use of bare stents.

Elective coronary stent implantation in cardiogenic shock complicating acute myocardial infarction: In‐hospital and six‐month clinical and angiographic results

Effective treatment of patients with acute myocardial infarction and cardiogenic shock depends on restoring persistent patency of the infarct-related artery. Coronary stenting, reducing abrupt or delayed closure related to dissection and suboptimal result, may improve PTCA results in cardiogenic shock. Eighteen patients (14 males and 4 females, mean age 59 ± 7 years), referred to catheterization laboratory for acute myocardial infarction and shock, had elective stent implantation during 14 primary and 4 rescue PTCA. Time delay between shock onset and PTCA was 4.1 ± 3 hr (range, 30 min to 12 hr). The IRA was LAD in seven patients (38%), LCx in two (11%), and RCA in eight (45%). One patient (5.%) had distal LMCA occlusion. Stent deployment was successful in 100% of patients and resulted in TIMI 3 flow in 13 (72%) patients. In 13 (72%) cases, cardiogenic shock gradually resolved and the patients were discharged alive. Five patients (28%) died because of irreversible hemodynamic deterioration without evidence of reinfarction. At 6-month follow-up, all the discharged patients were alive and no patient had reinfarction or recurrent angina. Heart transplant was required in one patient 5 months after stenting because of refractory congestive heart failure. Angiography demonstrated patency of all the coronary arteries treated, with TIMI 3 flow in all patients. Stent restenosis rate was 30%, and target lesion revascularization with CABG or re-PTCA was not required in any case. LV function improved from 39% ± 15% to 51% ± 15% (P < 0.01). Elective coronary stenting is an effective treatment for acute myocardial infarction complicated by cardiogenic shock and may improve acute and long-term survival. Cathet. Cardiovasc. Intervent. 50:384–389, 2000. © 2000 Wiley-Liss, Inc.

Intravascular low-power red laser light as an adjunct to coronary stent implantation: initial clinical experience.

Low-power red laser light (LPRLL) irradiation enhances endothelial cell growth in vitro and in vivo and reduces restenosis in animal models. The present study reports the preliminary clinical experience in our center. Eighty-one patients were treated with LPRLL, 30 mW/1 min, for in-stent restenosis (n = 27), elective stenting for recurrent restenosis (n = 16), and stenting for treatment of a suboptimal PTCA result (n = 38). All interventions were successful and no major adverse events due to LPRLL therapy were observed. At follow-up, 12 patients (14.8%) underwent an early control coronarogram due to target vessel restenosis. At 6 months, another 20 patients showed a significant restenosis of the target vessel. Preliminary clinical evaluation demonstrates that LPRLL is feasible and safe. The preliminary results suggest that LPRLL results in a decrease of in-stent restenosis when used during primary stenting.

Results of percutaneous transluminal coronary angioplasty of chronic total occlusion.

Background and Objective:Percutaneous transluminal coronary angioplasty of chronic total occlusion has been limited by a relatively low success rate and a high restenosis rate. This study investigated procedural outcome, factors predictive of procedural success and safety of coronary angioplasty for chronic total coronary occlusion. Materials and Methods:The study population was composed of 45 lesions attempting PTCA with or without stent implantation for recanalization of chronic total coronary occlusion between January 1997 and July 1999. The clinical and angiographic data of the 45 lesions were reviewed. The results of successful PTCA in 28 lesions were compared with those in 17 lesions whose PTCA was failed. Results: The overall success of balloon angioplasty and stenting was achieved in 28 lesions (62.2%) and did not differ significantly by clinical variables. The most common cause of failure of balloon angioplasty was inability to pass the guide wire across the occlusion (14 of 23 lesions, 61%). Procedural success was more common in patients with occlusions with a tapered entry configuration (77.2% vs. 47.8%, p=0.042), with lesions without side branches (82.3% vs. 50%, p=0.03). Multiple logistic regression analysis identified the absence of side branch (p 60%) of chronic total coronary occlusions can be successfully dilated by balloon angioplasty with or without stent implantation, with a major complication rate of 2.2%. Therefore, with careful patient selection, we need to try the aggressive recanalization for chronic total coronary occlusion. (Korean Circulation J 2000;30(4):416-423)

Influence of pre-PTCA strategy and initial PTCA result in patients with multivessel disease: the Bypass Angioplasty Revascularization Investigation (BARI).

In PTCA patients with multivessel coronary artery disease, incomplete revascularization (IR) is the result of both pre-PTCA strategy and initial lesion outcome. The unique contribution of these components on long-term patient outcome is uncertain. From the Bypass Angioplasty Revascularization Investigation (BARI), 2047 patients who underwent first-time PTCA were evaluated. Before enrollment, all significant lesions were assessed by the PTCA operator for clinical importance and intention to dilate. Complete revascularization (CR) was defined as successful dilatation of all clinically relevant lesions. Planned CR was indicated in 65% of all patients. More lesions were intended for PTCA in these patients compared with those with planned IR (2.8 versus 2.1). Successful dilatation of all intended lesions occurred in 45% of patients with planned CR versus 56% with planned IR (P<0. 001). In multivariable analysis, planned IR (versus planned CR), initial lesions attempted (not all versus all intended lesions attempted), and initial lesion outcome (not all versus all attempted lesions successful) were unrelated to 5-year risk of cardiac death or death/myocardial infarction but were all independently related to risk of CABG. Overall, a pre-PTCA strategy of IR in BARI-like patients appears comparable to a strategy of CR except for a higher need for CABG. Whether the use of new devices may attenuate the elevated risk of CABG in patients with multivessel disease and planned IR remains to be determined.

Do new devices add to the results of PTCA in acute myocardial infarction?

Several randomized trials have established that timely mechanical reperfusion with the use of balloon angioplasty is superior to thrombolytic therapy in patients with acute myocardial infarction. Furthermore, recent data from prospective randomized trials suggest that primary stent implantation may further improve the results of balloon angioplasty by reducing the need for repeat interventions at follow-up. The role of IIb-IIIa platelet receptor antagonists as adjunctive therapy to catheter-based coronary interventions in acute myocardial infarction is promising, but the incremental benefit that these agents add to stent implantation awaits the results of dedicated randomized trials. Mechanical thrombolysis or thrombectomy devices may have a role in a minority of patients with large thrombus burden. (Am Heart J 1999;138:S158-S163.)

Indications for intracoronary stent placement: the european view. Working Group on Coronary Circulation of the European Society of Cardiology.

In Europe, no written official guidelines on indications for coronary stent placement are available. We therefore assessed the opinions of European interventional cardiologists on these indications. In April 1997, a questionnaire was sent to the members of the Working Group on Coronary Circulation of the European Society of Cardiology with interventional cardiology as the main activity. A total of 165 questionnaires were returned and analysed. For the treatment of acute or threatened vessel closure during PTCA, the threshold for stenting is set at the level of a type C dissection by 42% of the cardiologists, while 22% stent any form of dissection and 13% require an impaired TIMI flow. A suboptimal PTCA result necessitating stenting is defined as a residual stenosis of >50% by 35% or of 30 >30% by 55% of the respondents. When considering primary prevention of restenosis, only 2% unconditionally stent focal, new-onset lesions in native coronary arteries, 44% refrain from stenting in a case of a stent-like PTCA result (</=30% residual stenosis) and 73% think that stent types other than the Palmaz-Schatz may be implanted for this indication. Restenotic lesions are unconditionally stented by 30% of the interventionists while 64% reserve this option only for suboptimal PTCA results. Amongst the other indications, stenting is considered to be the treatment of choice as follows: chronic total occlusion, 85%; saphenous vein graft lesions, 59%; aorto-coronary ostial lesions, 64%; and primary intervention for myocardial infarction: 59%. European interventional cardiologists have integrated current literature on stenting into their daily practice. The most cited indications (threatened vessel closure and suboptimal PTCA results) are not supported by randomized trials. The variations in the conclusions from randomized trials may be explained by the general expectation that stenting will improve PTCA results.

Does stent design influence restenosis?

Stents are now used in 40–80% of percutaneous coronary interventional procedures. This popularity is based upon extrapolation from available data, which discloses a better immediate angiographic appearance than after PTCA, an ability to ‘bail out’ poor PTCA results and superior late clinical and angiographic results compared with PTCA in certain lesion subsets. The enthusiasm for stents has translated into an outpouring of stent designs, each with competing claims for superiority. Meanwhile in-stent restenosis, although occurring in a smaller proportion of patients than restenosis after PTCA (in highly selected subsets), is the most important limiting factor of stenting. There are a number of reasons for this. First, it is frequent; though we are, as yet, not experiencing the epidemic that was first feared. The steadily increasing number of percutaneous procedures brings with it a concomitant number of stenting procedures. About half of these patients will experience a cardiac event in the 3 years after stenting. Second, more challenging lesions are being treated, so that the majority are ‘non-Benestent’, and may be expected to have a higher rate of in-stent restenosis than seen in the early trials. Third, in-stent restenosis is technically challenging to treat, especially when diffuse, in the setting of long stented segments and in bifurcations. Fourth, in-stent restenosis is preventing the use of stent implantation in a large number of patients and lesions, notably in small vessels and in the setting of diffuse disease. And yet there is very limited clinical evidence that one stent design is associated with a lower rate of in-stent restenosis than any other.

Usefulness of fractional flow reserve to predict clinical outcome after balloon angioplasty.

After regular coronary balloon angioplasty, it would be helpful to identify those patients who have a low cardiac event rate. Coronary angiography alone is not sensitive enough for that purpose, but it has been suggested that the combination of optimal angiographic and optimal functional results indicates a low restenosis chance. Pressure-derived myocardial fractional flow reserve (FFR) is an index of the functional severity of the residual epicardial lesion and could be useful for that purpose. In 60 consecutive patients with single-vessel disease, balloon angioplasty was performed by use of a pressure instead of a regular guide wire. Both quantitative coronary angiography (QCA) and measurement of FFR were performed 15 minutes after the procedure. A successful angioplasty result, defined as a residual diameter stenosis (DS) <50%, was achieved in 58 patients. In these patients, DS and FFR, measured 15 minutes after PTCA, were analyzed in relation to clinical outcome. In those 26 patients with both optimal angiographic (residual DS by QCA </=35%) and optimal functional (FFR >/=0.90) results, event-free survival rates at 6, 12, and 24 months were 92+/-5%, 92+/-5%, and 88+/-6%, respectively, versus 72+/-8%, 69+/-8%, and 59+/-9%, respectively, in the remaining 32 patients in whom the angiographic or functional result or both were suboptimal (P=0.047, P=0.028, and P=0.014, respectively). In patients with a residual DS </=35% and FFR >/=0.90, clinical outcome up to 2 years is excellent. Therefore, there is a complementary value of coronary angiography and coronary pressure measurement in the evaluation of PTCA result.

Balloon angioplasty of stent restenosis: early and late results of first and second PTCA in focal and diffuse stenosis

From January 1996 until February 1997 6,376 patients were treated by our group with PTCA and 3,859 (60.5%) received one or several stents. An angiographic followup was achieved in 63% of the patients with 1,267 experiencing restenosis (32.8%). Of those being treated with re-PTCA 302 were randomly selected for further analysis. In-stent-restenosis was treated with rotablator in 8 patients (2.7%), with eximer laser in 21 (7.0%) and with another stent in 48 patients (15.9%). 225 patients (74.4%) of this subselection were treated with balloon-angioplasty only. Mean patient age was 63 +/- 10.2 years, 401 stents had been implanted (42.5% Wiktor, 13.7% Jomed Sito, 12.3% ACS Multlink, 9.5% GR II, and some others), the number of stents per patient was 1.68, mean stent length 28.5 mm, mean stent diameter 3.01 +/- 0.3 mm, the time since implantation 142 +/- 76 days. The recurrence appeared as restenosis in 199 patients (88.4%) and as a chronic stent occlusion in 26 (11.6%). In-stent-restenosis was discovered in 94.7% within the stent and was of focal appearance (restenosic lesion of < or = 5 mm) in 28.5% and diffuse (> 5 mm) in 71.5%. Balloondilatation (balloon:artery = 1:1; maximal pressure 11.7 +/- 3.3 bar) was successfull in 98% of the stenotic lesions and in 18/26 of the chronically occluded stents (definition of success: residual stenosis < 50%, no major complications). The stenosis decreased from 82.2% to 20.5% (12.8% in focally stenosed vessels and 23.6% in diffuse restenosis). Complications were death in 0.9%, Q-MI in 0% CABG in 0.9%, Non-Q-MI in 2.4%, subacute stent thrombosis in 0.5% and groin bleeding in 1.8%. A clinical follow up after 151.7 +/- 87.7 days was achieved in 98.6% and an angiographic follow up in 69.1% of the patients: 1.9% had died (2/4 due to noncardiac disease), no MI, 6.2% CABG and 31% PTCA (TLR 37.2%). A second restenosis within the stents ocurred in 27.9% of those with focal disease and in 44.3% of those with diffuse in stent restenosis. Restenosis within stents may occurr in about 30% of unselected patients. In 2/3 these stenoses appear diffuse and in 10% they appear as chronic occlusions. Re-PTCA with balloons is rather simple with a high success rate (even in chronic stent occlusions) and a low complication rate. The incidence of a second restenosis is acceptably high in focal lesions but appears unacceptable in patients with diffuse in-stent-restenosis. Thus the indication for stenting should be restricted to patients with clear cut advantage over balloon-angioplasty alone, e.g. threatening closure, chronic occlusion, old savenous veingraft and proximal LAD stenosis.

Stents in the elderly for failed PTCA, early and intermediate term results

Stents in the elderly for failed PTCA, early and intermediate term results

1000–39 Advanced Age Does not Diminish the Results of PTCA for Acute Ischemic Syndromes

Advanced age has been recognized as adversely influencing the outcome of coronary revascularization procedures. To determine the validity of this relationship for patients (pts) with acute ischemic syndromes treated with contemporary medical therapy, the outcomes of 444 pts who had PTCA performed in TIMI IIIB were analyzed. Each pt received aspirin, heparin and antianginal therapy. Age &gt; = 65 (N = 154) % (mean) Age &lt; 65 (N = 290) % (mean) p-value Age (years) (69.7) (53.9) 0.000 Male Gender 51.9 73.8 0.000 Never Smoked 39.0 26.6 0.007 Prior MI 35.7 32.8 0.531 Hypertension 46.7 35.5 0.023 Non-Q-Wave MI 31.4 40.3 0.063 Abnormal ECG 92.9 94.1 0.597 LV EF (61.3) (58.7) 0.038 2 – 3 Vessel Disease 50.0 36.0 0.005 Angiographic Success 95.5 96.4 0.689 Events by 42 days Death 1.3 1.4 0.938 MI 6.5 5.5 0.671 Stroke 0.0 0.3 0.463 CABG 1.3 4.2 0.102 Death/MI/Stroke/CABG 8.4 9.0 0.864 In comparison to younger pts., elderly pts having PTCA in TIMI IIIB were more often female, had not smoked, had history of hypertension and had multivessel coronary disease. The results of PTCA were equally excellent in both groups. Thus, advanced age alone does not adversely affect the results of PTCA in selected pts with acute ischemic syndromes.

982-115 Gender Differences in Quality of Life Changes After Angioplasty

The performance and results of PTCA have been shown to vary between men and women. However, the effect of PTCA on modifying quality of life (QOL) in men vs. women has not been fully evaluated. Therefore the Medical Outcome Study (MOS-3S), a well validated, quantitative tool to measure (QOL). was administered to 113 consecutive patients, (69% men and 31% women), prior to and 6 months after undergoing elective PTCA. The (MOS36) includes 8 individual indices including: physical role (RP), bodily pain (BP), social function (SF), emotional role (ER), general health, vitality, physical functioning, and mental health. Serial changes of the (MOS-36) indices, in men and women, were compared and statistically analyzed. Statistically significant changes were obtained by both groups in physical roles and bodily pain, men in social function, and women in emotional roles (p &lt; 0,05). There were no significant differences in the other 4 indices. In conclusion, 1) (QOL) after PTCA can be quantitated by using the (MOS-36) in both men and women. 2) Gender differences do exist in (QOL) changes after PTCA. 3) Women have greater improvement in emotional roles, and men have greater improvement in social function. 4) Knowledge of gender differences in (QOL) changes after PTCA, may assist in patient care and outcome measurements.

734-4 Can Intracoronary Ultrasound Improve PTCA Results?: Preliminary Core Lab Ultrasound Analysis from the CLOUT Pilot Study

The CLOUT Pilot Study hypothesis is that intracoronary ultrasound (ICUS) guidance can maximize the potential of balloon angioplasty through the safe application of carefully chosen oversized balloons. PTCA was performed until success was obtained using standard angiographic criteria. ICUS was then performed and, based on the degree of reference segment disease, balloons were upsized from 0.25 to 0.75 mm (mean 0.4 mm) regardless of the angiographic results. There have been no complications using this strategy in the initial 14 of a planned 100 patients. ICUS measures were performed using semiautomated programs at a core laboratory. In the reference segment, ICUS revealed a mean lumen diameter of 2.60 ± 0.35 mm and plaque thickness of 0.78 ± 0.11 mm; on average 54.75 ± 11.05% of the reference vessel was occupied by atheroma. At initial ICUS evaluation after angiographically successful PTCA, the lesion had a minimal lumen diameter (MLD) of 1.78 ± 0.22 mm and lumen area of 3.14 ± 0.88 mm 2 . Following balloon upsizing, the lesion MLD increased to 1.95 ± 0.15 mm (8.7% gain, p &lt; 0.02) and lumen area to 3.76 ± 0.63 mm 2 (16.7% gain, p &lt; 0.01). When compared to the reference segment lumen area, the lesional %lumen area reduction improved from 38.14 ± 16.74% to 25.91 ± 12.17% (p &lt; 0.01). Lumen improvement occurred primarily by expansion of the total vessel area (12.08 ± 3.01 mm 2 to 12.51 ± 3.11 mm 2 , p = ns). As expected, there was a large degree of residual atheroma (68.62 ± 7.47% cross sectional narrowing). After routine PTCA, only 5 of 12 patients reached a target MLD of 75% of the reference lumen diameter. Following balloon upsizing, 8 of 12 had reached this criteria. ICUS guided balloon upsizing based on the degree of reference segment disease may be safely performed and results in significant improvement in luminal cross sectional area above that achieved by angiographic guidance alone. This may potentially lower restenosis rates if these initial gains are sustained long term.