E. Bertaglia et al., PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY IN REFRACTORY UNSTABLEANGINA-PECTORIS - ARE NEW DEVICES USEFUL, International journal of cardiology, 57(1), 1996, pp. 1-7
This study was undertaken to assess if the introduction of new angiopl
asty devices (autoperfusion balloon catheters, stent and atherectomy)
could ameliorate early and late results of prompt percutaneous translu
minal coronary angioplasty (PTCA) in patients with refractory unstable
angina. From January 1993 to June 1995, 59 of 278 patients (14 female
, 45 male; mean age: 61+/-10 years; range: 38-78) admitted to our Coro
nary Care Unit with the diagnosis of unstable angina had more than one
episode of chest pain at rest with dynamic electrocardiographic ST-T
changes and without signs of cardiac necrosis while on medical therapy
including oxygen, aspirin, heparin, nitroglycerin and either a beta-b
locker or a calcium-antagonist. Coronary angiography was performed wit
hin 48 h from the last ischemic attack and a culprit lesion technicall
y suitable for PTCA was identified. PTCA was performed in 73 lesions.
Elective stent implantation was considered for 16 type B or C lesions
in 14 patients. The procedure was initially successful in 52/59 patien
ts (88%), uncomplicated unsuccessful in 4/59 (7%) and complicated in 3
/59 (5%). Elective stent insertions were all successful (16/16, 100%).
All successfully treated patients were followed up for a mean of 12+/
-7 months (range: 6-27): 2/52 patients (3.8%) suffered from non-transm
ural myocardial infarction, 14/52 (26.9%) had a recurrence of angina a
nd 2/52 (3.8%), asymptomatic, had a positive stress test. We conclude
that prompt PTCA in refractory unstable angina using 1990s 'state of t
he art' equipment compares favorably to previous study and that stent
delivery might become the elective treatment of complex lesions in thi
s subset of patients.