SYMPTOMATIC AND SILENT-MYOCARDIAL-ISCHEMI A BEFORE AND AFTER PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

The aim of the present study was to prove the effect of successful per cutaneous transluminal coronary angioplasty (PTCA) on the occurrence o f symptomatic and silent myocardal ischemia recorded during 24-h ECG, considering the number of diseased coronary arteries, a history of myo cardial infarction, and the interval between myocardial infarction and PTCA. Before PTCA, 28 of 56 patients (50 %) had ischemic ST-segment a lterations, 3-8 days thereafter, there were only 13 patients (23 %) wi th signs of myocardial ischemia (p < 0.01). The number of episodes of ischemia (IE) was reduced 44 % (p < 0.05), their duration (ID) 51 % (p < 0.01). In symptomatic patients, the decrease was 67 % (p < 0.05) an d 83 % (p < 0.05), in patients with silent myocardial ischemia 20 % (n .s.) and 29 % (n.s.). Patients with one-vessel disease exhibited a 73 % reduction of IE (p < 0.01) and a 85 % reduction of ID (p < 0.01). In patients with two-vessel disease, the decrease was 47 % (p < 0.05) an d 26 % (P < 0.05), whereas in those with three-vessel disease, there w as no significant change. Patients without stenosis (< 50 %) after PTC A had - irrespective of primary findings - a decrease of IE of 78 % (p < 0.05) and of ID of 85 % (p < 0.05), while patients with persisting coronary artery stenosis exhibited no significant decrease (20 % and 3 5 %, n.s.). In patients without history of myocardial infarction, the reduction of IE was 79 % (p < 0.01) and that of ID 85 % (p < 0.05); in patients with recent myocardial infarction (< 3 months) the decrease was 59 % (p < 0.05) and 70 % (p < 0.05). In contrast, patients with an old myocardial infarction (> 3 months) had no significant reduction o f IE and ID. The results demonstrate that in many patients, successful PTCA results in a significant reduction of ST-segment alterations due to myocardial ischemia. This holds true above all for symptomatic pat ients, for those with one-vessel disease, and for patients without his tory of myocardial infarction.