[A report of the survey on the present application of percutaneous transluminal coronary angioplasty in Japan].
To elucidate the current use of percutaneous transluminal coronary angioplasty (PTCA) in Japan, questionnaires concerning PTCA experience in 1986 and indications for using PTCA were sent to 53 relatively experienced centers. The results were collected from 46 centers (87%), and the data were analyzed. A total of 5,255 PTCA were performed in 1986, which was 35% greater than that in 1985. Of these, 4,440 PTCA procedures were performed in patients with angina. Primary success was achieved in 3,790 patients (85%), and complications included 21 deaths (0.5%), 41 emergency bypass surgery (CABG) (0.9%), and 118 myocardial infarction (MI) (2.7%). Another 815 PTCA procedures were performed in patients with acute myocardial infarction, of which 58% were direct PTCA and 42% were PTCA following thrombolysis. Primary success was achieved in 674 patients (83%) with complications of deaths in 19 (2.3%) and emergency CABG in 17 (2.1%). The initial treatments in patients with significant coronary stenosis diagnosed by initial coronary arteriography in 1986 were analyzed. In 6,845 patients with angina or old myocardial infarction, medical treatment was selected in 46%, PTCA in 40% and CABG in 14%. In 1,506 patients with acute infarction, medical treatment was performed in 21%, PTCA including PTCA following thrombolysis in 44%, CABG in 3% and only coronary thrombolysis in 32%. Questions on criteria required to select patients for PTCA and clinical or angiographic indications for PTCA were also asked. The following conditions were not necessarily required in more than half of the centers: symptoms, refractoriness to medical treatment and surgical candidates. However, evidence of myocardial ischemia and viability of the lesion-related myocardium were required as criteria in the majority of centers. The following clinical or angiographic features were not always indicated in more than two-third of centers: i.e. cardiogenic shock, and 90% or less stenosis in acute infarction, 75% stenosis in variant angina, patients over 80 years old, poor cardiac function with 29% or less ejection fraction, severely calcified coronary lesions, long segment lesions (greater than or equal to 2 cm), distal lesions, unprotected left main trunk lesions, total obstructions (of more than three months duration), and three vessel disease with two total occlusions and one discrete lesion.
Yamaguchi
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Center for Cardiovascular Disease, Mitsui Memorial Hospital, Tokyo.
D000368:Aged; D000787:Angina Pectoris / Q000628:therapy; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan; D009203:Myocardial Infarction / Q000628:therapy