IS THERE A PROGNOSTIC INDICATION FOR PTCA

Coronary angioplasty is classically indicated to remove a high grade s tenosis of a major coronary vessel supplying a large myocardial territ ory in a symptomatic patient with proven myocardial ischemia. The coro nary anatomy has to be suitable for PTCA to ensure a high successrate for the procedure. PTCA is performed to remove symptoms and myocardial ischemia to improve the prognosis of the patient. In contrast to this , the term ''prognostic indication'' describes an interventional appro ach to an angiographically documented high grade stenosis in an asympt omatic patient without proven myocardial ischemia thereby hoping to im prove the prognosis of this patient. It has to be expected, that up to 20 % of all patients treated by balloon angioplasty and 10 % of all s tented patients are treated with respect to a ''prognostic indication' '. Until now, there are no statistically significant large-scale studi es supporting a benefit of an interventional therapy performed with a ''prognostic indication'' in asymptomatic patients without ischemia. N evertheless, some certain subgroups of patients may be candidates for a ''prognostic indication'' to angioplasty compared to the results of medical therapy. In patients treated interventionally for a ''prognost ic indication'' the acute and long-term individual risk of the underly ing coronary disease must be carefully weighted against the risk of th e interventional procedure.