Da. Halon et al., LONG-TERM (10-YEAR) OUTCOME IN PATIENTS WITH UNSTABLE ANGINA-PECTORISTREATED BY CORONARY BALLOON ANGIOPLASTY, Journal of the American College of Cardiology, 32(6), 1998, pp. 1603-1609
Objectives. We sought to examine completed 10-year survival and event-
free survival in patients with stable and unstable angina pectoris tre
ated by coronary balloon angioplasty. Background. Patients with unstab
le angina are at increased risk for recurrent acute coronary events. M
ethods. The study included 208 consecutive patients (133 with stable a
nd 75 with unstable angina pectoris) undergoing angioplasty from 1984
to 1986. The balloon crossed the lesion in 185 patients (121 with stab
le and 64 with unstable angina pectoris). Angioplasty was performed in
patients with unstable angina pectoris 12 +/- 15 days (median 8) afte
r symptom onset. Patients with unstable angina pectoris were classifie
d retrospectively into Braunwald class I (n = 3), class II (n = 20), c
lass III (n = 28), class B (n = 52) and class C (n = 12). Follow-up da
ta were obtained from hospital charts, telephone interview and officia
l death certificates where applicable. The study had >80% power to det
ect a clinically significant 20% difference in survival and a 20% diff
erence in event-free survival between the stable and unstable patient
groups. Results. Despite similar baseline characteristics, early (40-d
ay) mortality was slightly higher in patients with unstable angina (4.
7% [3 of 64 patients] vs. 0.8% [1 of 121 patients], p = NS). Long-term
outcome,vas not different, because survival curves were parallel ther
eafter (10-year survival was 83% for those with stable and 77% for tho
se with unstable angina, p = NS). Survival free of myocardial infarcti
on or coronary artery bypass graft surgery at 10 years was 53% in pati
ents with stable and 47% in patients with unstable angina (p = NS), an
d survival free of infarction, bypass surgery or repeat angioplasty wa
s 32% for both groups at 10 years. In patients with Braunwald class II
I unstable angina, 10-year sunival was 80%, as compared with 85% in ot
her patients with unstable angina, due to the early hazard (p = NS). S
urvival and event-free survival were similar in patients who had had a
recent myocardial infarction (Braunwald class C) and in patients with
acute electrocardiographic changes. Repeat hospital admissions were n
ot more frequent in patients with unstable angina (3.1 +/- 3.5 vs. 3.0
+/- 2.6, p = NS). Conclusions. Ten-year survival and event-free survi
val were similar in patients with stable and unstable angina pectoris
treated by coronary balloon angioplasty, with no evidence of an increa
sed rate of recurrent cardiovascular events in the unstable group. (J
Am Coll Cardiol 1998;32:1603-9) (C)1998 by the American College of Car
diology.