Percutaneous transluminal coronary angioplasty in patients with unstable angina pectoris refractory to medical therapy: long-term clinical and angiographic results.

The purpose of this study was to assess the results of percutaneous transluminal coronary angioplasty (PTCA) in 469 consecutive patients with unstable angina pectoris refractory to medical therapy. The primary success rate was 88%, but, since the introduction of the steerable wire system, the success rate has increased to 90%. Mortality was 1%. There were no statistically significant differences in success rates per vessel. Actuarial total 5 year survival was 94%. After 5 years, actuarially, 79% of the patients were free of events (recurrence of angina, residual myocardial infarction, re-PTCA, coronary artery bypass surgery or death). Aortocoronary bypass surgery was performed in 9% of the 469 patients. The angiographic recurrence rate was 28%, but, of the patients who were symptom-free and who had a follow-up angiogram, only 3% had an angiographic recurrence, whereas 98% of the patients who did not have a repeat angiogram were symptom-free. It is concluded that, in a selected group of patients with the clinical syndrome of unstable angina pectoris refractory to medical therapy, the long-term clinical results are good and survival is excellent.