The continuing evolution of percutaneous transluminal coronary angioplasty in the treatment of coronary artery disease.
PTCA in patients with stable angina and single-vessel disease alleviates symptoms more completely than medical therapy alone; it may also reduce the development of unstable angina and result in fewer hospitalizations. PTCA and bypass surgery in patients with multivessel disease are associated with a similar incidence of endpoints such as myocardial infarction and death, but surgery offers more complete initial revascularization and results in fewer repeat invasive procedures. In patients with unstable angina, a strategy of obligatory invasive management is not warranted, but many patients will fail to stabilize on medical therapy alone and will require anatomic revascularization. PTCA as a primary means of revascularization in acute myocardial infarction has been shown to result in fewer recurrent ischemic events than thrombolytic therapy, but its applicability is limited by practical operational considerations. The benefits of PTCA as a salvage tool after failed thrombolysis are yet to be fully defined. The routine use of PTCA after successful thrombolysis is not warranted. The efficacy of PTCA for cardiogenic shock is difficult to evaluate because of the lack of adequately controlled data. However, the clinical imperative to act has driven PTCA to the forefront in the management of patients with cardiogenic shock. Second-generation devices are expanding the role of precutaneous interventions in the management of coronary artery disease.
Vaitkus
P T
PT
Cardiology Unit, University of Vermont College of Medicine, Burlington 05401, USA.
D015906:Angioplasty, Balloon, Coronary; D017225:Atherectomy, Coronary; D003327:Coronary Disease / Q000628:therapy*; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic; D012770:Shock, Cardiogenic / Q000628:therapy; D015607:Stents; D015912:Thrombolytic Therapy; D017211:Treatment Failure; D016896:Treatment Outcome