[Percutaneous revascularization with coronary angioplasty in patients with refractory angina]. / Revascularización percutánea mediante angioplastia coronaria en pacientes con angina refractaria.

INTRODUCTION AND OBJECTIVES: Refractory angina, specially when accompanied by electrocardiographic (ECGs) changes, has been associated with a high morbidity and mortality if urgent revascularization is not performed. Percutaneous Transluminal Coronary Angioplasty (PTCA) could be a useful therapeutic alternative in such cases. The aim of this study was to compare the immediate and midterm outcomes of a cohort of high risk patients with refractory angina with or without ECG changes revascularized by PTCA. METHODS: Of 801 consecutive patients who underwent PTCA, we selected 48 patients (49 procedures, 61 lesions), with unstable angina in spite of treatment with nitroglycerin, calcium channel blockers, beta blockers, heparin and aspirin (refractory angina). Twenty-six patients (27 procedures, 37 lesions) had ECG changes (group A), and 22 patients (22 PTCAs, 24 lesions) did not have changes (group B). RESULTS: Mean age of patients was 65 +/- 11 years. The most frequent ECG changes found in group A were T wave inversion (38%) and ST segment depression (34%). The left anterior descending coronary artery was the most frequent dilated vessel (41%). Some new devices (Stent, Rotablator, etc.) were used in 22% vs 25% of lesions in group A and B respectively. Successful dilatation was achieved in 59 (96%) of attempted lesion without statistical differences between group A and B. One patient in each group developed an acute myocardial infarction. Death occurred in 2 patients from group A (one of non-cardiovascular cause). Follow-up was obtained in 33 (94%) of the 35 patients (minimum follow-up > or = 6 months or less if a major event occurred). Mean follow-up time was 16.7 +/- 6 vs 13.4 +/- 6 months in group A and B. During this time, death occurred in 2 patients (6%) both from group B (one non-cardiac); in 9 (27%) patients a repeat PTCA was performed (26% of patients from group A and 28% from B); CABG was performed in 2 (6%) patients (both from group B), and an AMI occurred in 1 patient in each group. Angiographic follow-up was obtained in 73% of patients in group A vs 91% in group B. The restenosis rate was 47% in group A vs 54% in group B. At the end of the first year of follow-up, 93% of patients were alive and 9/10 patients successfully revascularized were asymptomatic or had less severe angina. CONCLUSIONS: At present, PTCA is a safe revascularization method in patients with refractory angina providing a high initial success (95% of cases) and a good mid-term outcome (one year): > 90% survival rate, with improvement in the quality of life in 9/10 patients successfully revascularized, regardless of the presence or absence of ECG changes at the time of PTCA.

[Estimating the angiographic risk from isotopic ventriculography in ischemic heart disease]. / Estimación del riesgo angiográfico a partir de la ventriculografía isotópica en cardiopatía isquémica.

The objective of this study was to determine the diagnostic accuracy of the ejection fraction (EF) measurement, calculated by isotopic ventriculography, to predict the angiographic risk in a group of patients with previous acute myocardial infarction and significant segmentary disturbance of wall motility. A total of 125 patients were studied (100 males and 25 females, aged 23 to 78 years). Isotopic EF showed positive and negative predictive values of 85% and 93.3%, respectively, for the low risk group. The corresponding values for the moderate risk group (angiographic EF from 31% to 54%) were 80.3% and 79.6%. And for the high risk group (angiographic EF < 31%) 89.4% and 83%. In conclusion, from the present work we state that with a high probability isotopic EF places each patient in his/her corresponding high, moderate, or low angiographic (biological) risk.