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Role of percutaneous transluminal coronary angioplasty in the treatment of unstable angina

Report from the national heart, lung, and blood institute percutaneous transluminal coronary angioplasty and coronary artery surgery study registries
  • David P. Faxon
    Correspondence
    Address for reprints: David P. Faxon, MD, University Hospital, 75 East Newton Street, Boston, Massachusetts 02118.
    Affiliations
    From the Division of Medicine, Evans Department of Clinical Research and the Department of Medicine, University Hospital, Boston, Massachusetts USA

    From the Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania USA

    From the University of Washington, Seattle, Washington USA

    From the Mayo Clinic, Rochester, Minnesota USA

    From the Medical College of Virginia, Charlottesville, Virginia USA

    From the Montreal Heart Institute, Montreal, Canada; and Participating Sites
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  • Katherine M. Detre
    Affiliations
    From the Division of Medicine, Evans Department of Clinical Research and the Department of Medicine, University Hospital, Boston, Massachusetts USA

    From the Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania USA

    From the University of Washington, Seattle, Washington USA

    From the Mayo Clinic, Rochester, Minnesota USA

    From the Medical College of Virginia, Charlottesville, Virginia USA

    From the Montreal Heart Institute, Montreal, Canada; and Participating Sites
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  • Carolyn H. McCabe
    Affiliations
    From the Division of Medicine, Evans Department of Clinical Research and the Department of Medicine, University Hospital, Boston, Massachusetts USA

    From the Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania USA

    From the University of Washington, Seattle, Washington USA

    From the Mayo Clinic, Rochester, Minnesota USA

    From the Medical College of Virginia, Charlottesville, Virginia USA

    From the Montreal Heart Institute, Montreal, Canada; and Participating Sites
    Search for articles by this author
  • Lloyd Fisher
    Affiliations
    From the Division of Medicine, Evans Department of Clinical Research and the Department of Medicine, University Hospital, Boston, Massachusetts USA

    From the Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania USA

    From the University of Washington, Seattle, Washington USA

    From the Mayo Clinic, Rochester, Minnesota USA

    From the Medical College of Virginia, Charlottesville, Virginia USA

    From the Montreal Heart Institute, Montreal, Canada; and Participating Sites
    Search for articles by this author
  • David R. Holmes
    Affiliations
    From the Division of Medicine, Evans Department of Clinical Research and the Department of Medicine, University Hospital, Boston, Massachusetts USA

    From the Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania USA

    From the University of Washington, Seattle, Washington USA

    From the Mayo Clinic, Rochester, Minnesota USA

    From the Medical College of Virginia, Charlottesville, Virginia USA

    From the Montreal Heart Institute, Montreal, Canada; and Participating Sites
    Search for articles by this author
  • Michael J. Cowley
    Affiliations
    From the Division of Medicine, Evans Department of Clinical Research and the Department of Medicine, University Hospital, Boston, Massachusetts USA

    From the Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania USA

    From the University of Washington, Seattle, Washington USA

    From the Mayo Clinic, Rochester, Minnesota USA

    From the Medical College of Virginia, Charlottesville, Virginia USA

    From the Montreal Heart Institute, Montreal, Canada; and Participating Sites
    Search for articles by this author
  • Martial G. Bourassa
    Affiliations
    From the Division of Medicine, Evans Department of Clinical Research and the Department of Medicine, University Hospital, Boston, Massachusetts USA

    From the Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania USA

    From the University of Washington, Seattle, Washington USA

    From the Mayo Clinic, Rochester, Minnesota USA

    From the Medical College of Virginia, Charlottesville, Virginia USA

    From the Montreal Heart Institute, Montreal, Canada; and Participating Sites
    Search for articles by this author
  • Mark Van Raden
    Affiliations
    From the Division of Medicine, Evans Department of Clinical Research and the Department of Medicine, University Hospital, Boston, Massachusetts USA

    From the Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania USA

    From the University of Washington, Seattle, Washington USA

    From the Mayo Clinic, Rochester, Minnesota USA

    From the Medical College of Virginia, Charlottesville, Virginia USA

    From the Montreal Heart Institute, Montreal, Canada; and Participating Sites
    Search for articles by this author
  • Thomas J. Ryan
    Affiliations
    From the Division of Medicine, Evans Department of Clinical Research and the Department of Medicine, University Hospital, Boston, Massachusetts USA

    From the Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania USA

    From the University of Washington, Seattle, Washington USA

    From the Mayo Clinic, Rochester, Minnesota USA

    From the Medical College of Virginia, Charlottesville, Virginia USA

    From the Montreal Heart Institute, Montreal, Canada; and Participating Sites
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      The acute and long-term consequences of PTCA performed in patients with unstable angina was determined in 442 patients with 1-vessel CAD who were enrolled in the NHLBI PTCA Registry. These patients were compared with 214 similar patients in the PTCA Registry with stable angina and with 330 patients with unstable angina from the NHLBI CASS Registry who underwent CABG. The 3 groups had similar baseline characteristics. The immediate angiographic success after PTCA was not different between patients with stable and those with unstable angina. The in-hospital mortality rate was 0.9 % for the PTCA group with unstable angina and 0.47% for the PTCA group with stable angina. The combined 18-month mortality and MI rate was low in both groups (10.8 and 9.5%, respectively). No differences were observed in the mortality and MI rates between patients with unstable angina treated surgically or with PTCA. Both revascularization procedures markedly reduced symptoms of angina. Ninety-two percent of the PTCA group reported improvement in their angina, whereas 80 % of the surgical group had a reduction in angina (p < 0.05). The results from this observational study suggest that PTCA can be performed as safely and successfully in patients with unstable angina as in those with stable angina. PTCA compares favorably with CABG in patients with unstable angina in that the procedure is associated with low mortality and morbidity rates, while marked improvement in symptoms can be expected. Thus, PTCA could be considered an alternative to CABG in patients with unstable angina who have the appropriate anatomic characteristics.
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