title: Value of visual versus central quantitative measurements of angiographic success after percutaneous transluminal coronary angioplasty. NHLBI PTCA Registry Investigators.
abstract: This study examined the optimal angiographic definition for long-term success after angioplasty and compared visual and quantitative angiographic measurements in assessing outcome. The National Heart, Lung, and Blood Institutes--Percutaneous Transluminal Coronary Angioplasty Registry prospectively followed 1,768 patients from 15 clinical centers. Symptom-free survival, defined as survival without angina, myocardial infarction, bypass surgery, or death, occurred in 59% of patients. In a subset of 393 patients, quantitative coronary angiography (QCA), done at a core angiographic laboratory, was compared with visual site readings. Although there was considerably more variability for visual readings, a site reading of a change in percent stenosis of >20% correlated highly with symptom-free survival (64.6% for patients who had all lesions successfully dilated, 48% for patients with partial success, and only 21% for patients without angiographic success; p < 0.001). Similar findings were seen for other angiographic definitions, but a change of > 20% was most discriminatory. In contrast, QCA readings had little or no predictive value. This study confirms that visual assessment of the immediate change in percent stenosis is predictive of a successful 1-year outcome. A change of greater than 20% is most discriminatory and should still be used to define angiographic success. QCA does not appear to be superior to visual assessment in predicting 1-year outcome.
authors.affiliation: Division of Cardiology, University of Southern California, School of Medicine, Los Angeles, USA.
authors.forename: D P
authors.initials: DP
authors.lastname: Faxon
authors.forename: R
authors.initials: R
authors.lastname: Vogel
authors.forename: W
authors.initials: W
authors.lastname: Yeh
authors.forename: D R
authors.initials: DR
authors.lastname: Holmes
authors.forename: K
authors.initials: K
authors.lastname: Detre
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D003251:Constriction, Pathologic; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies