Results of coronary angioplasty of chronic total occlusions (the National Heart, Lung, and Blood Institute 1985-1986 Percutaneous Transluminal Angioplasty Registry).
There has been increasing application of coronary angioplasty to patients with chronic total occlusions. The acute and long-term outcome in 271 patients after coronary angioplasty (142 single and 129 multiple stenoses) of a total occlusion was compared with 1,429 patients undergoing angioplasty of subtotal (less than or equal to 99% stenosis) occlusions (885 single and 544 multilesion) participating in the 1985-1986 National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry. Baseline characteristics were similar for each lesion group except for a higher incidence of prior myocardial infarction and left ventricular dysfunction (ejection fraction less than 50%) in patients with total occlusion. Major complications (death, myocardial infarction or emergency bypass surgery) were similar (p = not significant) between patients with total and subtotal occlusions for single (6 vs 7%) and multilesion angioplasty (9 vs 6%). At 2 years, after making adjustments for baseline variables, patients with a total occlusion had a significantly increased risk of death compared with those with subtotal occlusion. There were no significant differences in cumulative event rates for myocardial infarction or bypass surgery. Approximately three-fourths of patients in each group were free of angina at 2 years. In conclusion, angioplasty of chronic total occlusions is associated with a similar acute complication rate. Despite similar relief of anginal symptoms, patients in the total occlusion group have a higher 2-year mortality.
Ruocco
N A
NA
Evans Memorial Department of Clinical Research, University Hospital, Boston, Massachusetts 02118.
Ring
M E
ME
Holubkov
R
R
Jacobs
A K
AK
Detre
K M
KM
Faxon
D P
DP
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000473:pathology / Q000628:therapy*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009316:National Institutes of Health (U.S.); D016016:Proportional Hazards Models; D012042:Registries; D016896:Treatment Outcome; D014481:United States