Coronary angioplasty in patients who were considered poor bypass surgery candidates.
In most patients who undergo coronary angioplasty (PTCA), coronary bypass surgery (CABG) is an alternative.  Patients with severe symptoms secondary to coronary disease, amenable to PTCA, but who are poor CABG candidates are commonly seen.  From April 1988 to December 1989 PTCA was performed in 751 patients.  Patients with evolving infarction (47) were excluded.  Of the remaining 704, 605 were considered candidates for CABG and they were compared to the 99 patients not felt to be candidates for CABG.  The objective of this report was to compare these 2 patient groups.  These salvage PTCA patients were older, had a higher incidence of heart failure, more prior CABG, higher left ventricular end-diastolic pressure and lower ejection fraction (all p less than 0.01).  PTCA had a high success rate per lesion in both groups (96% CABG candidates vs. 95% salvage patients), but there were more patients whose culprit lesion could not be dilated in the salvage group (14% vs. 7%, p less than 0.02). Severe complications including Q wave infarction (2% vs. .3%) and in-hospital death (7% vs. 0.2%) were more common in salvage patients. As planned, emergency CABG was not performed on any salvage PTCA patient but on 2.6% of the other patients.  Patients who may benefit from PTCA but were not felt to be operable made up 13% of our PTCA experience. PTCA can be performed in these patients but risks were increased.
Munroe Regional Medical Center, Ocala Heart Institute, FL 32671.
R L
RL
Feldman
M
M
Carmichael
M
M
Domingo
W
W
Dresen
R
R
Eligeti
R
R
Fox
M
M
Jesrani
C
C
Kuykendall
V
V
Maffei
S
S
Martin
D000367:Age Factors; D000368:Aged; D000789:Angina, Unstable / Q000150:complications; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000706:statistics & numerical data*; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications; D012307:Risk Factors