Percutaneuos Coronary Angioplasty in Argentina. In Hospital and Follow-up Results. Conarec V Registry

pp 163-174

Abstract

Background

Percutaneous transluminal coronary angioplasty is a safe method of revascularization for patients with ischemic cardiopathy. The available information about follow-up clinical events is scarce in Argentina.

Objectives

To analize in-hospital results of percutaneous transluminal coronary angioplasty in our country and determine long-term event predictors in patients with clinical success.

Material and method

The registry prospectively included 1,295 consecutive patients who underwent percutaneous transluminal coronary angioplasty, at 41 medical centers with cardiology residency programs, during six months of 1996. Angiographic success was defined as a residual stenosis <_ 30% and clinical success as angiographic success free of in-hospital major events (death, acute myocardial infarction or urgent coronary artery bypass graft surgery). Clinical events during follow-up included death, myocardial infarction, need of a new percutaneous transluminal coronary angioplasty or coronary artery bypass graft surgery. Follow-up (431 ± 230days) was completed in 1,023 patients (91.7%) of1,115 with clinical success.

Results

Median age was 60.6 ± 10.9 years and male gender78.3%. Thirty percent of the patients had a previous myocardial infarction, 16% a previous percutaneous translurminal coronary angioplasty and10.6% a previous coronary artery bypass graft surgery. Coronary angioplasty was performed in patients with stable angina pectoris in 18.2%, with unstable angina in 60.5% and with acute myocardial infarction in 21.3%. In-hospital clinical success rates and mortality during follow-up was86.7% and 2.6% in stable angina pectoris, 88.8% and3% in unstable angina, 79.4% and 10.3% in primary angioplasty, 58.8% and 5.6% in rescue angioplasty and 87% and 2.6% in post-infarct elective angioplasty. Rates of new percutaneous transluminal coronary angioplasty, coronary artery bypass graft surgery and clinical event rates during follow-up were 9.6%, 3.2% and 14.9% in patients with stableangina pectoris, 12.5%, 7.6% and 22% in patients with unstable angina, 9.3%, 5.2% and 21.2% in patients with myocardial infarction, respectively. Ina multivariate analysis, coronary angioplasty during acute ischemic syndromes (OR1.7, CL 95%:1.05-2.77), previous angioplasty (OR 1.6, CL 95% 1.10-2.32), diabetes (OR 1.53, CL 95% 1.07-2.19), male gender (OR 1.57, CL 95% 1.02-2.43), one vessel dis-ease (OR 0.73, CL 95% 0.54-0.99) and stent implantation (OR 0.70, CL 95% 0.52-0.95) were independent event predictors during follow-up.

Conclusions

In-hospital results and follow-up clinical event rates after successful percutaneous transluminal angioplasty are similar to published data. A previous angioplasty, coronary angioplasty during acute ischemic syndromes, diabetes, one vessel disease, stent implantation and male gender were independent event predictors.