CONAREC V. Percutaneous Transluminal Coronary Angioplasty. Registry in Argentina. In-Hospital Results

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Abstract

Background Percutaneous transluminal coronary angioplasty is accepted as a method of revascularization for patients with ischemic syndromes. Efficacy and safety of this procedure in Argentina is unknown. Objectives To analyze the clinical and angiographic characteristics of patients treated with angioplasty, to determine its indications and to evaluate angio-graphic and clinical success of the procedure and its complications. Material and method The registry prospectively included, during six months in 1996, 1295 consecutive patients undergoing coronary angioplasty at 41 medical centers with cardiology residency training programs. Angiographic success was defined as a residual stenosis <_ 30% and clinical success as angiographic success without in-hospital death, acute myocar-dial infarction or urgent coronary artery bypassgraft surgery. Results One thousand fourteen men and 281 women were included and the average ages were 59.2 ± 10.6 years and 65.5 ± 10.3 years, respectively. They presented the following coronary risk factors: hypertension (61.3%), dyslipemia (55.4%) and diabetes (16.9%) Thirty percent of the patients had a previous myocardial infarction, 10.6% a previous coronary artery bypass graft surgery and 15.9% a previous percutaneous coronary angioplasty; 18.2% of procedures were performed in patients with stable angina pectoris, 60.5% in patients with unstable angina(previously stabilized with pharmacologic therapy76.4%, recurrent unstable angina 14.2%, refractary unstable angina 9.4%) and 21.3% in patients with acute myocardial infarction (primary angioplasty 51.3%, rescue angioplasty 12.4% and elective angioplasty 36.3%); the percentage of patients with single and double vessel disease were 55,6% and 29.5% respectively and 59% had good or mildly depressed left ventricular function. Stent was used in 48% of the patients, rotational atherectomy in 4.1% and directional in 0.1%. Clinical success and death rates were 86.7% and 0.8% in stable angina pectoris, 88.8% and 1% in unstable angina, 79.4%and 13.5% in primary angioplasty (86% and 4.3%in Killip-Kimball I), 58.8% and 20.6% in rescue angioplasty (72.7% and 0% in Killip-Kimball I), 87%and 5% in post-infarct elective angioplasty. Angio-graphic success was achieved in 73% of patients with acute myocardial infarction complicated with cardiogenic shock (n = 37) and mortality in this group was 51%. Abrupt vessel closure and coronary dissection occurred in 4.6% and 9.9% of the patients respectively. Clinical complications included pseudoaneurysm in 0.7%, major hematoma in 1.5%, acute renal failure in 1.6%, hemodialysis in 0.7%,and cerebrovascular accident in 0.5%. Conclusions The majority of the procedures were done in pa-tients with acute coronary syndromes previously stabilized under pharmacologic therapy, with single vessel coronary disease and good or slightly depressed left ventricular function. The angiographic and clinical success rates were similar to published data and confirmed the safety of percutaneous transluminal coronary angioplasty.