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National heart, lung and blood institute registry report of complications of percutaneous transluminal coronary angioplasty
BENEFICIAL RESULTS FROM TRANSLUMINAL CORONARY ANGIOPLASTY ;;;X;;;D BY QUANTITATIVE CROSS-SECTIONAL CORONARY ARTERI-
LEFT VENTRICULAR FUNCTION BEFORE AND AFTER SUCCESSFUL CATHETER DILATATION OF CRITICAL CORONARY STENOSES
Robert K. Mito, M.D., Albert E. Raizner, M.D., FACC, John ----T--M. Lewis, M.D., FACC, William L. Winters, Jr., M.D., FACC, Richard R. Miller, M.D., FACC, Baylor College of Medicine and The Methodist Hospital, Houston, Texas.
Ulrich SIGWART MD, FACC, Milan GRBIC MD, Axe1 ESSINGER MD, Angelika BISCHOF-DELALOYE MD, Hossein SADEGHI MD, Jean-Louis RIVIER MD, FACC. - Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Translurninal coronary angioplasty is a relatively new procedure, the efficacy of which is not firmly established. Quantitative assessment of stenosis severity and effects of dilatation is needed to more accurately measure its effects. Consequently, a technique of quantitating cross-sectional stenosis and normal lumen area using biplane measurements and computing area based on an elliptical model [(a/Z)' x (b/2)* x n] (a = short axis and b = long axis) was applied to eight patients (four native coronaries and four bypass grafts) who underwent "successful" coronary angioplasty. Before angioplasty, mean cross-sectional stenosis area was 1.36 mm* (range 0.45 to 2.57 mn*) and cross-sectional percent stenosis was 84.5% (ranye 63.7 to 95.1%). Trans-stenosis gradient was present in seven of eight and ranged from 5 to 65 nnnHg (mean 27.1 mnHg). Following angioplasty, mean crosssectional stenosis area was 5.28 (1111' (range 2.08 to 17.12 mm') (p < .05 from preop) and cross-sectional percent stenosis was 47.5% (range 1.3 to 85%) (p < .Ol). Mean percent improvement in stenosis was 37.0% (range 9.1 to 90.1%). Concomitantly, trans-stenosis gradient was eliminated in six of the seven patients with pre-angioplasty gradients. Thus, improvement in stenosis severity can be documented by quantitative cross-sectional coronary arteriography and reflects hemodynamic improvement. This arteriographic technique may be applied in the serial evaluation of coronary angioplasty patients.
Left ventricular (LV) function was studied in seven patients one day before and six months after successful catheter dilatation(D) of critical LAD stenoses. LV and A0 pressures with tipmanometers and thermodilution cardiac output were taken at rest (R) and during submaximal bicycle exercise (E) in the supine position as well as during isoproterenol (I) infusion. Ejection fraction at R and during E was estimated by gated blood pooling scintigraphy. Hemodynamics at R before and 6 months after dilatation were not significantly different. LV EDP during E was 35.8+4.5mmHg before and ZO.l+Z.&nmHg 6 months after D. LV SVI at E augmented from 79+11 to 110+15ml. per beat after D. LV dP/dt max. failed-to change-significantly but dP/dt min. normalized from -1550+95 to -ZOOO+llOmmHg /sec. during E suggesting improved relaxation. DPTI/SPTI ratio was 0.5+0.15 before and 0.8+0.1 after dilatation, and during I abnormal LV contractility parameters improved as well. LV ejection fraction at R was normal and not significantly different before and after D ; exercise
EVALUATION OF TRANSLUMINAL CORONARY ANGIOPLASTY IN LEFT
NATIONAL HEART, LUNG AND BLOOD INSTITUTE REGISTRY REPORT OF COMPLICATIONS OF PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY
M4IN CORONARY ARTERY STENOSIS
Siron H. Stertzer, MD, FACC; Eugene Wallsh, MD, FACC; Michael S. Bruno, MD., Lenox Hill Hospital, New York, NY Eight attempts at transluminal coronary angioplasty (PTCA) were made in left main coronary artery stenosis (LMCAS) over a 27 month period. There were 7 males and 1 female; mean age 51 years (range 45-54). All patients had multivessel coronary artery disease. Three patients had previously undergone open heart surgery (2, coronary bypass surgery (cABG); 1, aortic valve replacement). Six patients underwent PTCA via the brachial approach while 2 were treated by the femoral. All patients had Canadian Heart Class (CHA) III or IV angina1 syndromes. One patient had severe preinfarctional angina requiring intraaortic balloon support. All 8 left main orifices were entered with the guiding catheter. All 8 lesions were passed with the dilatation catheter. All left main stem lesions improved initially angiographically. Mean percent stenosis before angioplasty was 75% (range 60 to 90). Mean increase in coronary distal pressure after PTCA was 48 n Hg (range 33 to 65 nsn Hg). Mean percent stenosis after left main PTCA was 32% (range 5 to 60%). All patients improved at least 1 CHA class after PTCA, and 4 were Class I. No patient died or required emergency operation. Two patients (25%) experienced recurrence within 12 months. Three patients in all required delayed CABG surgery either because of residual left main stem stenosis, recurrence, or because of remote multivessel disease. Two patients improved markedly with PTCA after CABG alone did not satisfactorily relieve their angina. The preinfarctional patient with IABP avoided surgery completely. It is conclt ed that despite concern regarding PTCA in LMCAS the pn :edure is feasible without increased risk in selected cases.
396
February 1961
The American Journal ol CARDIOLOGY
ejection fraction, however, improved after dilatation from 52+7.8% to 63+6.4%. It is concluded that E tolerance and parameters of left ventricular function during dynamic E can be improved in patients after successful D of critical LAD stenoses.
Gerald Dorros, MD, FACC; Michael Cowley, MD, FACC; John Simpson, MD; Members of Executive Committee of NHLBI-PTCA Registry, Lutheran Hospital of Milwaukee, Inc., and Medical College of Wisconsin, Milwaukee, Wisconsin. Since September, 1977, data have been collected on 632 patients (pts) who have undergone percutaneous transluminal coronary angioplasty (PTCA) from 34 centers. There were 664 PTCA's attempted with 393 (59.2%) primary successes. In 123 (19.5%) pts, there were 152 (22.9%) complications, 57 (8.6%) with sequelae and 95 (14.3%) without sequelae. The 57 complications with sequelae occurred in 52 pts (8.2%) and included: hospital deaths in 6 (0.9%) (1 directly related, 4 probably related, and 1 unrelated to PTCA); myocardial infarctions (MI) in 23 (3.5%): 11 MI's in pts with, and 12 MI's in pts without coronary artery bypass surgery (CABG) within 24 hours; coronary occlusion in 18 (2.7%); vascular complications requiring surgery ifi8 (1.2%); and others, 3 (0.5%). The 95 complications without sequelae occurred in 71 (11.2%) pts and included: coronary artery dissection in 22 (3.3%); prolonged angina in 18 (2.7%); bradycardia requiring therapy in 12 (1.8%); coronary spasm in 12 (1.8%); hypotension requiring therapy in 9 (1.3%); ventricular fibrillation in 7 (1.1%); excessive blood loss in 7 (1.1%); ventricular tachycardia in 3 (0.5%); and others, 5 (7.5%). CABG was performed on 108 pts within 24 hours. There were 44 (7.0%) emergency pts, with evidence of a MI developing in 10 (22.7%). There were 64 (10.1%) elective pts. The incidence of complications occurring with PTCA, to date, is not negligible, even though the complications with sequelae are less than 10%. The mortality and morbidity with PTCA appears comparable to those reported with CABG.
Volume 47
LEFT VENTRICULAR FUNCTION BEFORE AND AFTER SUCCESSFUL CATHETER DILATATION OF CRITICAL CORONARY STENOSES
Robert K. Mito, M.D., Albert E. Raizner, M.D., FACC, John ----T--M. Lewis, M.D., FACC, William L. Winters, Jr., M.D., FACC, Richard R. Miller, M.D., FACC, Baylor College of Medicine and The Methodist Hospital, Houston, Texas.
Ulrich SIGWART MD, FACC, Milan GRBIC MD, Axe1 ESSINGER MD, Angelika BISCHOF-DELALOYE MD, Hossein SADEGHI MD, Jean-Louis RIVIER MD, FACC. - Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Translurninal coronary angioplasty is a relatively new procedure, the efficacy of which is not firmly established. Quantitative assessment of stenosis severity and effects of dilatation is needed to more accurately measure its effects. Consequently, a technique of quantitating cross-sectional stenosis and normal lumen area using biplane measurements and computing area based on an elliptical model [(a/Z)' x (b/2)* x n] (a = short axis and b = long axis) was applied to eight patients (four native coronaries and four bypass grafts) who underwent "successful" coronary angioplasty. Before angioplasty, mean cross-sectional stenosis area was 1.36 mm* (range 0.45 to 2.57 mn*) and cross-sectional percent stenosis was 84.5% (ranye 63.7 to 95.1%). Trans-stenosis gradient was present in seven of eight and ranged from 5 to 65 nnnHg (mean 27.1 mnHg). Following angioplasty, mean crosssectional stenosis area was 5.28 (1111' (range 2.08 to 17.12 mm') (p < .05 from preop) and cross-sectional percent stenosis was 47.5% (range 1.3 to 85%) (p < .Ol). Mean percent improvement in stenosis was 37.0% (range 9.1 to 90.1%). Concomitantly, trans-stenosis gradient was eliminated in six of the seven patients with pre-angioplasty gradients. Thus, improvement in stenosis severity can be documented by quantitative cross-sectional coronary arteriography and reflects hemodynamic improvement. This arteriographic technique may be applied in the serial evaluation of coronary angioplasty patients.
Left ventricular (LV) function was studied in seven patients one day before and six months after successful catheter dilatation(D) of critical LAD stenoses. LV and A0 pressures with tipmanometers and thermodilution cardiac output were taken at rest (R) and during submaximal bicycle exercise (E) in the supine position as well as during isoproterenol (I) infusion. Ejection fraction at R and during E was estimated by gated blood pooling scintigraphy. Hemodynamics at R before and 6 months after dilatation were not significantly different. LV EDP during E was 35.8+4.5mmHg before and ZO.l+Z.&nmHg 6 months after D. LV SVI at E augmented from 79+11 to 110+15ml. per beat after D. LV dP/dt max. failed-to change-significantly but dP/dt min. normalized from -1550+95 to -ZOOO+llOmmHg /sec. during E suggesting improved relaxation. DPTI/SPTI ratio was 0.5+0.15 before and 0.8+0.1 after dilatation, and during I abnormal LV contractility parameters improved as well. LV ejection fraction at R was normal and not significantly different before and after D ; exercise
EVALUATION OF TRANSLUMINAL CORONARY ANGIOPLASTY IN LEFT
NATIONAL HEART, LUNG AND BLOOD INSTITUTE REGISTRY REPORT OF COMPLICATIONS OF PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY
M4IN CORONARY ARTERY STENOSIS
Siron H. Stertzer, MD, FACC; Eugene Wallsh, MD, FACC; Michael S. Bruno, MD., Lenox Hill Hospital, New York, NY Eight attempts at transluminal coronary angioplasty (PTCA) were made in left main coronary artery stenosis (LMCAS) over a 27 month period. There were 7 males and 1 female; mean age 51 years (range 45-54). All patients had multivessel coronary artery disease. Three patients had previously undergone open heart surgery (2, coronary bypass surgery (cABG); 1, aortic valve replacement). Six patients underwent PTCA via the brachial approach while 2 were treated by the femoral. All patients had Canadian Heart Class (CHA) III or IV angina1 syndromes. One patient had severe preinfarctional angina requiring intraaortic balloon support. All 8 left main orifices were entered with the guiding catheter. All 8 lesions were passed with the dilatation catheter. All left main stem lesions improved initially angiographically. Mean percent stenosis before angioplasty was 75% (range 60 to 90). Mean increase in coronary distal pressure after PTCA was 48 n Hg (range 33 to 65 nsn Hg). Mean percent stenosis after left main PTCA was 32% (range 5 to 60%). All patients improved at least 1 CHA class after PTCA, and 4 were Class I. No patient died or required emergency operation. Two patients (25%) experienced recurrence within 12 months. Three patients in all required delayed CABG surgery either because of residual left main stem stenosis, recurrence, or because of remote multivessel disease. Two patients improved markedly with PTCA after CABG alone did not satisfactorily relieve their angina. The preinfarctional patient with IABP avoided surgery completely. It is conclt ed that despite concern regarding PTCA in LMCAS the pn :edure is feasible without increased risk in selected cases.
396
February 1961
The American Journal ol CARDIOLOGY
ejection fraction, however, improved after dilatation from 52+7.8% to 63+6.4%. It is concluded that E tolerance and parameters of left ventricular function during dynamic E can be improved in patients after successful D of critical LAD stenoses.
Gerald Dorros, MD, FACC; Michael Cowley, MD, FACC; John Simpson, MD; Members of Executive Committee of NHLBI-PTCA Registry, Lutheran Hospital of Milwaukee, Inc., and Medical College of Wisconsin, Milwaukee, Wisconsin. Since September, 1977, data have been collected on 632 patients (pts) who have undergone percutaneous transluminal coronary angioplasty (PTCA) from 34 centers. There were 664 PTCA's attempted with 393 (59.2%) primary successes. In 123 (19.5%) pts, there were 152 (22.9%) complications, 57 (8.6%) with sequelae and 95 (14.3%) without sequelae. The 57 complications with sequelae occurred in 52 pts (8.2%) and included: hospital deaths in 6 (0.9%) (1 directly related, 4 probably related, and 1 unrelated to PTCA); myocardial infarctions (MI) in 23 (3.5%): 11 MI's in pts with, and 12 MI's in pts without coronary artery bypass surgery (CABG) within 24 hours; coronary occlusion in 18 (2.7%); vascular complications requiring surgery ifi8 (1.2%); and others, 3 (0.5%). The 95 complications without sequelae occurred in 71 (11.2%) pts and included: coronary artery dissection in 22 (3.3%); prolonged angina in 18 (2.7%); bradycardia requiring therapy in 12 (1.8%); coronary spasm in 12 (1.8%); hypotension requiring therapy in 9 (1.3%); ventricular fibrillation in 7 (1.1%); excessive blood loss in 7 (1.1%); ventricular tachycardia in 3 (0.5%); and others, 5 (7.5%). CABG was performed on 108 pts within 24 hours. There were 44 (7.0%) emergency pts, with evidence of a MI developing in 10 (22.7%). There were 64 (10.1%) elective pts. The incidence of complications occurring with PTCA, to date, is not negligible, even though the complications with sequelae are less than 10%. The mortality and morbidity with PTCA appears comparable to those reported with CABG.
Volume 47