The clinical efficacy and scintigraphic evaluation of post-coronary bypass patients undergoing percutaneous transluminal coronary angioplasty for recurrent angina pectoris

https://doi.org/10.1016/0002-8703(89)90657-1Get rights and content

Abstract

The efficacy of percutaneous transluminal angioplasty in improving recurrent anginal symptoms and myocardial perfusion after coronary artery bypass graft surgery was assessed prospectively in 55 patients, of whom 50 had an initial angiographic and clinical success. Although 80% of those successfully dilated were initially free of angina at 23 ± 11 months of follow-up, one half of these patients had recurrent angina. Although only 48% of the patient cohort had complete relief of angina, 94% had less angina than before dilatation and 86% were able to decrease antianginal medications. Fifteen patients with persistent or recurrent angina had from one to five repeat dilatations. After angioplasty, lung thallium uptake, the extent of abnormal scan segments, and the magnitude of redistribution in dilated lesions were significantly reduced (n = 24 patients). Redistribution defects were seen in 38% of patients on postangioplasty scans. All were associated with subsequent angina. Of various clinical, angiographic, exercise, and thallium-201 scan variables, only the presence of delayed redistribution was an independent predictor of recurrent angina. Restenosis was the most common underlying cause for this exercise-induced perfusion defect. Thus percutaneous coronary angioplasty performed as primary therapy for recurrent angina after bypass surgery is moderately successful in long-term follow-up for the amelioration of symptoms and enhancement of regional myocardial perfusion.

References (55)

  • DR Rosing et al.

    Three-year anatomic, functional, and clinical follow-up after successful percutaneous transluminal coronary angioplasty

    J Am Coll Cardiol

    (1987)
  • E Berger et al.

    Sustained efficacy of percutaneous transluminal coronary angioplasty

    Am Heart J

    (1986)
  • HV Schaff et al.

    The morbiolity and mortality of reoperation for coronary artery disease and analysis of late results with use of actuarial estimate of event free survival

    J Thorac Cardiovasc Surg

    (1983)
  • FD Loop et al.

    Trends in selection and results of coronary artery reoperation

    Ann Thorac Surg

    (1983)
  • ED Foster et al.

    Comparison of operative mortality and morbidity results for initial and repeat coronary artery bypass grafting: the coronary artery surgery study (CASS) registry experience

    Ann Thorac Surg

    (1984)
  • P Ganz et al.

    Usefulness of transstenotic coronary pressure gradient measurements during diagnostic catheterization

    Am J Cardiol

    (1985)
  • W Wijns et al.

    Early detection of restenosis after successful percutaneous transluminal coronary angioplasty by exercise-redistribution thallium scintigraphy

    Am J Cardiol

    (1985)
  • B Canhasi et al.

    Interaction of “supplementary” scintigraphic indicators of ischemia and stress electrocardiography in the diagnosis of multivessel coronary disease

    J Am Coll Cardiol

    (1985)
  • TM Bateman et al.

    Diffuse slow washout of myocardial thallium-201: a new scintigraphic indicator of extensive coronary artery disease

    J Am Coll Cardiol

    (1984)
  • MS Verani et al.

    Quantitative analysis of thallium-201 uptake and washout before and after transluminal coronary angioplasty

    Int J Cardiol

    (1986)
  • J Gutman et al.

    Time to complete redistribution of thallium-201 in exercise myocardial scintigraphy

    Am Heart J

    (1983)
  • BF Waller et al.

    Morphologic observations after percutaneous transluminal balloon angioplasty of early and late aortocoronary saphenous vein bypass grafts

    J Am Coll Cardiol

    (1984)
  • Eleven-year survival in Veterans Administration randomized trial of coronary bypass surgery for stable angina

    N Engl J Med

    (1984)
  • T Killip et al.

    Coronary artery surgery study (CASS): a randomized trial of coronary bypass surgery; eight years follow-up and survival in patients with reduced ejection fraction

    Circulation

    (1985)
  • BJ Mauer et al.

    Changes in grafted and nongrafted coronary arteries following saphenous vein bypass grafting

    Circulation

    (1974)
  • MJ Cowley et al.

    Coronary angioplasty of multiple vessels: short-term outcome and long-term results

    Circulation

    (1985)
  • JF Marquis et al.

    Percutaneous transluminal angioplasty of coronary saphenous vein bypass grafts

    Can J Surg

    (1985)
  • Cited by (0)

    Supported in part by grant R01 HL-26205 from the National Heart, Lung, and Blood Institute.

    View full text