Angioplasty: further intervention was common.

Clinical bottom line (level 2a)

  1. Between 70 and 80% of patients post-angioplasty were symptom-free at 5 years.
  2. Annual mortality rate was between 1 and 2% for most patients; those with multi-vessel disease were at high risk.
  3. 20% of patients required repeat angioplasty and 10% require CABG over the next 5 years.
de Feyter et al: Progress in Cardiovascular Diseases 1994; 36 (5): 385-396
Expires July 2003

The study

Systematic review of all studies of
  • Patients: underwent successful percutaneous transluminal coronary angioplasty (PTCA) and were symptom-free at last follow-up and indication of long-term symptom-free survival and major cardiac event rates
  • Outcome: death, MI, bypass surgery


    • Articles found in English using MEDLINE, 1978 to 1993 (search terms: percutaneous transluminal coronary angioplasty and outcome or prognosis ) and bibliographies were also searched for other relevant articles.

    Selection criteria: not detailed
    Appraisal criteria: not detailed
    Articles excluded if:

    28 studies (12941 patients)- 11 double blind RCTs, 1 cohort study. Medium term (<5 years)- five studies of 4039 patients. Long term (>5 years)- three studies of 1776 patients
    No test for heterogeneity was performed.

    The evidence

    • Death rate per person-year:
      • <5 years: 2.0%
      • > 5 years: 1.0%
    • MI rate per person-year:
      • < 5 years: 1.9%
      • >5 years: 1.6%
    • Redilatation rate:
      • <5 years: 16%
      • >5 years: 19%
    • Elective bypass surgery:
      • <5 years: 10%
      • >5 years: 18%
    • Symptom-free at last follow-up:
      • <5 years: 72%
      • >5 years: 77%
    • outcome after PTCA <5 years: death/year:
      • unstable angina- 2.0%
      • single-vessel disease- 1.3%
      • multi-vessel disease- 2.3%
      • left anterior descending lesion- 1.3%
    • outcome after PTCA <5 years: MI/year:
      • unstable angina- 1.7%
      • single-vessel disease- 1.6%
      • multi-vessel disease- 2.5%
      • left anterior descending lesion- 0.8%
    • outcome after PTCA <5 years: redilatation rate:
      • unstable angina- 15%
      • single-vessel disease- 19%
      • multi-vessel disease- 21%
      • left anterior descending lesion- 17%
    • outcome after PTCA <5 years: elective bypass surgery:
      • unstable angina: 8.0%
      • single-vessel disease: 13%
      • multi-vessel disease: 12%
      • left anterior descending lesion: 76%
    • outcome after PTCA <5 years: symptom-free at last follow-up:
      • unstable angina- 68%
      • single-vessel disease- 81%
      • multi-vessel disease- 73%
      • left anterior descending lesion- 76%
    • Better long-term outcome if:
      • single-vessel disease
      • anterior descending artery stenosis
    • The outcome of PTCA in patients with multi-vessel disease was determined by the extent and severity of the lesions.

    Comments

    1. No comparison with other interventions (eg. CABG or medical therapy).
    2. The review methods are not rigorous and there is no consideration of random variability.
    3. The outcomes from difference studies may not be comparable because of differences in patient selection treatment policies and length of follow-up. Subgroups not adjusted for confounding factors.
    4. Since coronary stent implantation has been widely spread and the advances in PTCA technique and other equipment including adjunctive medical treatment have been achieved in the present day, this article may not offer good information particularly regarding long-term outcomes.

    Citation

    1. de Feyter PJ, Keane D, Deckers JW, et al: Medium- and long-term outcome after coronary balloon angioplasty. Progress in Cardiovascular Diseases 1994; 36 (5): 385-396
    Search Terms: angioplasty in Cochrane
    Contributor: Nick Shenker and Chris Ball, July 2000
    Reviewer: Etsuo Tsuchikane

    Clinical Question.
    Patient angina
    Intervention or Exposure successful PTCA
    Outcome MI, pain, revascularisation, CABG