Present status and perspective of percutaneous transluminal coronary angioplasty from the viewpoint of short and long term results: comparative study of the results of PTCA and CABG procedure.
Balloon technology has advanced to incorporate the skills of angioplasters while efforts to enhance their skills continue. These factors have contributed to the expansion of percutaneous transluminal coronary angioplasty (PTCA) indications. We have analyzed the comparison of short and long term results between PTCA and CABG revascularization procedures. In the development of revascularization procedures, one graft surgery has significantly declined in use since 1983 (2 years after the start of PTCA) while there has been an increase of multi graft surgery (more than 2 grafts). On the other hand, PTCA has showed a linear increase since 1982 and reached 160 cases in 1985. The growth of complex angioplasty other than PTCA for single discrete lesions is parallel to that of PTCA and has been used in 44% of overall cases. The growth curve of angioplasty crossed over that of revascularization surgery in 1983. PTCA was successful in 246 patients out of 300 overall cases representing 88% success rate and in 340 lesions representing an 81% success. For CABG the patency rate was 89.5% which means a out of 638 grafts were successful. PTCA was conducted in 137 cases with multiple lesion. That data could be interpreted as mean patient success of 120/137, lesion success was 196/265 with a success rate of 88% and 73%, respectively. Primary results in 284 multi CABG cases were good with a patency rate of 91% (487 patent grafts out of 536 anastomoses). However, in-hospital deaths were 3.5% higher (10 cases with CABG group). The effective dilatation of high-grade organic lesion was found to be closely related to the improvement of clinical symptoms and a marked decrease in incidence of ergonovine induced spasms at the angioplasty site in patients with vasospastic angina (VSA). Thus PTCA can be accepted as an alternative therapy to CABG in VSA. In the long term follow up, work load response parameters such as exercise time, % predicted HR, PRP, Mets and the modified treadmill exercise scores improved significantly after the successful PTCA.
D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000628:therapy; D000800:Angioplasty, Balloon; D001161:Arteriosclerosis / Q000401:mortality / Q000628:therapy*; D001026:Coronary Artery Bypass; D005069:Evaluation Studies as Topic; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D014654:Vascular Patency