Predictors of Successful Percutaneous Transluminal Coronary Angioplasty

Jeong, Myung Ho; Park, Chan Hyung; Cho, Jeong Gwan; Park, Jong Chun; Kang, Jung Chaee

Abstract

OBJECTIVES
Percutaneous transluminal coronary angioplasty (PTCA) was recently introduced in the treatment of coronary artery disease and initially applied in stable angina patients with proximal, discrete, single vessel disease, but complex PTCA including total occlusion in unstable angina and myocardial infraction has become feasible with increased operator experience in the clinical practice of PTCA. The author analyzed the predictive factors concerning the success rate of PTCA.
METHODS
To evaluate the predictive factors of the successful PTCA, clinical and angiopraphic factors of 238 patients with 281 attempted lesions (mean age: 58.3+/-9.0, 217 male, 64 female), who admitted to Chonnam University Hospital from January 1991 to December 1992, were analyzed.
RESULTS
1) Overall success rate of 281 attempted lesions was 90.0%. Success rate of stable angina was significantly higher than those of acute, old myocardial infraction and unstable angina. Success rates of American Heart Association (AHA) type C lesion, right coronary arterial lesion, total occlusion of longer duration (above 3 months), low TIMI (Thrombolysis in Myocardial Infraction) flow (below 1) was significantly lower than those of the counter control group. Complications related to PTCA were 2 myocardial infraction, 2 vessel rupture, 4 distal embolization, 15 nonocclusive coronary dissection, 1 aortic dissection, 1 guide wire entrapment, 2 cardiogenic shock and 1 heart failure (i.e. 10.0% of studied subjects). 2) In old age group above 65 years, PTCA was successful in 46 out of 52 lesions and success rate of PTCA was 90.4%. Success rates of PTCA with multivessel or multilesional involvement, total occlusion and TIMI flow below 1 were lower than those of single vessel lesion, subtotal occlusion and TIMI flow above 2. 3) In PTCA of total occlusion, PTCA was successful in 26 out of 36 lesions and success rate of PTCA was 72.2%. Success rates of PTCA in younger age group below 65 years and shorter duration of total occlusion below 3 months were higher than those of older age group and longer duration of total occlusion. 4) In multivessel PTCA, PTCA was successful in 78 out of 84 lesions and success rate was 92.9%. Success rate of PTCA in acute myocardial infraction, AHA type C lesion, low TIMI flow were lower than those of old myocardial infraction, stable and unstable angina, type A, B1, B2, and higher TIMI flow rate. 5) In PTCA of unstable angina, PCTA was successful in 77 out of 98 lesions and success rate of PTCA was 87.8%. Success rates of PTCA in total occlusion lesion and lower TIMI flow were significantly lower than those of subtotal occlusion and higher TIMI flow. 6) In PTCA of acute myocardial infraction, PTCA was successful in 82 out of 95 lesions and success rate was 86.3%. Success rates of PTCA in AHA lesion type C and lower TIMI flow were lower than those of type, A, B1, B2 and higher TIMI flow.
CONCLUSION
These results suggest that clinical factors and angiographic findings of lesion type and flow rate are important in the prediction of successful PTCA, and that PTCA in patients with severe ischemic symptoms, coronary angiographic findings with total occlusion, type C lesion and lower TIMI flow below 1 are related to lower success rates.