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Outcomes have improved significantly for patients undergoing coronary angioplasty
The first human coronary angioplasty was performed in 1977, and now an estimated 1 million such procedures are performed worldwide each year. During the procedure, a balloon catheter is inserted into a blocked coronary artery. When inflated, it flattens plaque against the arterial wall and opens up the artery. The good news is that outcomes for patients undergoing coronary angioplasty appear to have improved significantly since the early 1990s, according to a study supported in part by the Agency for Healthcare Research and Quality (HS06813).
Researchers from the Northern New England Cardiovascular Disease Study Group collected data from 1990 to 1997 on 34,752 percutaneous coronary interventions (PCIs) performed at all hospitals in Maine (two), New Hampshire (two), and Vermont (one) supporting these procedures, and one hospital in Massachusetts. They defined clinical success as at least one coronary artery lesion dilated to less than 50 percent blockage and no adverse outcomes, such as coronary artery bypass graft surgery (CABG; emergency CABG is usually due to failed angioplasty), heart attack, or death.
Success rates improved during the 1990s, even though the patients undergoing angioplasty tended to be older, had more coexisting medical problems (ranging from diabetes to renal failure), and had more complex lesions. After adjustment for patient case mix, clinical success improved from a low of 88 percent in earlier years to a peak of 92 percent in recent years. The rate of emergency CABG surgery after PCI fell in recent years from a peak of 2.3 percent to 1.3 percent. Mortality rates also decreased slightly from 1.2 percent to 1.1 percent. Over the past 20 years, the increasing experience of surgeons and hospitals, the advent of newer technologies (including coronary stents), and a variety of adjuvant drug therapies have led to more successful procedures and decreased the complications associated with PCIs.
For more information, see "Changing outcomes in percutaneous coronary interventions," by Paul D. McGrath, M.D., M.Sc., David J. Malenka, M.D., David E. Wennberg, M.D., M.P.H., and others, in the September 1999 Journal of the American College of Cardiology 34(3), pp. 674-680.
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