Percutaneous transluminal coronary angioplasty: role of the surgeon.

Over a recent one-year period, 339 patients underwent percutaneous transluminal coronary angioplasty (PTCA) and were compared with 338 patients having isolated coronary artery bypass surgery. Patients undergoing PTCA had a shorter duration of angina, a lower number of prior myocardial infarctions, and better left ventricular function (p less than 0.01); PTCA was considered initially successful in 87% (295/339) of patients. Repeat angioplasty was performed in 18% of patients (34/339), with a successful outcome in all but 1. The most common finding at operation in those with failed angioplasty and urgent or emergency revascularization was dissection of an atheromatous plaque. There were 28 early failures (operation performed within 24 hours) and 24 late failures (operation at more than 24 hours), for early and late failure rates of 8.3% and 7.1%, respectively. Although the cumulative frequency of new Q-waves in the entire angioplasty series was low (2.7%), the incidence was high in those with angioplasty failure and subsequent operation (18%), and was significantly greater than in patients having elective coronary bypass (3.6%). Use of inotropic agents and lidocaine treatment for ventricular arrhythmias was also significantly higher in patients with unsuccessful PTCA who required operation than in those undergoing elective bypass (10% versus 3% and 10% versus 1.5%, respectively; p less than 0.01). Eleven of the 28 patients who were early failures were totally revascularized within 2 hours of angioplasty failure. Facilities and staff available for expedient revascularization accounted for the low morbidity and lack of mortality in PTCA failures.