Coronary angioplasty for medically refractory unstable angina within 30 days of acute myocardial infarction.
Percutaneous transluminal coronary angioplasty (PTCA) has been used with good results in selected patients with unstable angina. The population with recent (less than or equal to 30 days) infarction and unstable angina is a subject of controversy. This report reviews the results of angioplasty of 84 vessels in 66 patients with medically refractory unstable angina who had documented myocardial infarction within 30 days of the procedure. Of these 66 patients, 54 had rest angina. Of the 66 patients with angioplasties, 58 patients (88%) had successful procedures. Two patients had technically unsuccessful results in the only vessel attempted; one went to elective surgery and recovered uneventfully and the other patient was in cardiogenic shock at the time of the procedure and died 12 hours later. There were three acute occlusions of infarct-related arteries that were managed medically. There were two (3%) emergency coronary artery bypass graft (CABG) procedures. There were two (3%) deaths during the index hospitalization. Of the 58 of 66 patients with technically successful angioplasty, all 58 had no more rest angina, and 46 had a satisfactory predischarge exercise test. All 46 were without angina at exercise. In follow-up ranging from 4 months to 36 months (14 months mean), there have been six cases of restenosis with recurrence of angina treated successfully with repeat angioplasty. There have been five late bypass surgeries. There have been three late deaths. These data, generated by a single operator in a Veterans Administration (VA) center, support the use of angioplasty in patients with unstable angina and recent myocardial infarction. The data suggest that a VA prospective randomized trial of PTCA versus CABG for post-infarction angina may be feasible.
Morrison
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DA
Denver Veterans Administration Medical Center, CO 80220.
D000787:Angina Pectoris / Q000628:therapy*; D000789:Angina, Unstable / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D000792:Angiography; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications*; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors