Percutaneous transluminal coronary angioplasty (PTCA) in patients with relative contraindications: results of the National Heart, Lung, and Blood Institute PTCA Registry.
The effects of relative contraindications on the immediate results of PTCA were investigated in 1,939 patients, and on long-term results in 998 patients with isolated stenosis of 1 coronary artery. Immediate results subjected to analysis were: success rate, major complications (coronary occlusion, MI and death) and emergency CABG. The analysis of long-term results included: status of angina pectoris, occurrence of MI, restenosis, repeat PTCA, CABG and death. Unstable angina and previous MI had no negative effects on immediate results, whereas a significantly lower success rate was noted in patients with angina for more than 1 year compared to patients with angina of shorter duration (p less than 0.05) and patients older than 60 years compared with younger patients (p less than 0.01). During follow-up, patients with unstable angina had higher CABG rate (p less than 0.01); the other relative clinical contraindications to PTCA did not exert adverse effects. Angiographically, there was a lower immediate success rate in patients with nonproximal stenosis (p less than 0.001) and in patients with calcium in the affected artery (p less than 0.01) and at the site of stenosis (p less than 0.001). Patients with tubular or diffuse stenoses had similar success rates but higher rates of complications, excluding death, than those with discrete stenoses (p less than 0.01). Patients with eccentric stenoses had a lower success rate and a higher rate of complications and emergency CABG than patients with concentric stenoses (p less than 0.001 for all 3 variables).(ABSTRACT TRUNCATED AT 250 WORDS)
D000368:Aged; D000787:Angina Pectoris / Q000628:therapy; D000800:Angioplasty, Balloon / Q000009:adverse effects; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D003331:Coronary Vessels; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy; D009316:National Institutes of Health (U.S.); D012008:Recurrence; D012042:Registries; D012306:Risk; D013997:Time Factors; D014481:United States