PTCA Long - term exercise performance after percutaneous transluminal coronary angioplasty and coronary artery bypass grafting

In our first 169 consecutive patients admitted to undergo percutaneous transluminal coronary angioplasty (PTCA) serial bicycle ergometric exercise sessions were scheduled to assess long-term exercise performance. In 160 of these 169 patients (95%) an average of seven ergometric measurements were available during a mean follow-up period of 29 months (range 1 to 60 months). Two groups were formed. One consisted of 132 patients in whom PTCA was successful and the other consisted of 28 patients with failure of PTCA who subsequently underwent coronary artery bypass grafting (CABG) either on an emergency basis (12 patients) or as an elective procedure (16 patients). Exercise performance was expressed as work capacity in watts according to the highest completed exercise stage. In the successful PTCA group the actual work capacities increased from 74 + 42 W (mean + SD) before PTCA to 122 ± 47 W at the most recent follow-up examination. In patients who underwent emergency or elective CABG the respective figures were 73 ± 34 or 65 ± 37 W before surgery and 120 ± 41 or 119 + 41 W at the most recent follow-up examination (p < .005 for all preprocedure to postprocedure comparisons). Successful PTCA and CABG after failed PTCA improve work capacity significantly. Comparison of our results with those of surgical studies indicates that a failed attempt at PTCA before CABG does not compromise the functional outcome of the operation, regardless whether it is done on an emergency or on an elective basis. Circulation 68, No. 4, 796-802, 1983. IN THE FIRST PATIENTS we treated with percutaneous transluminal coronary angioplasty (PTCA) serial bicycle exercise tests were done in an ongoing prospective study to determine the immediate and long-termn functional outcome of the operation. Comparisons were possible between patients in whom PTCA was successful and those in whom it failed and who underwent subsequent coronary artery bypass grafting (CABG). Previous studies have shown that PTCA is able to restore coronary blood flow, alleviate symptoms, and improve left ventricular perfusion and work capacity. 1' Other reports have addressed the topic of the use of exercise tests to determine outcome ifi patients who undergo CABG5-15; in some of these studies results were compared with those in a group receivFrom the Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, and Department of Medicine, University Hospital, Zurich. Address for correspondence: Andreas R. Gruentzig, M.D., Division of Cardiology, Emory University School of Medicine, 1364 Clifton Rd., Atlanta, GA 30322. Received April 22, 1983; revision accepted June 16, 1983. Maria Schlumpf is a clinical technologist specializing in PTCA at the University Hospital of Zurich and supported by a grant from USCI, Billerica, MA. ing drug treatment."'5 Their results serve as a standard for the surgically treated patients described in this report. Patients and methods Between September 1977 and October 1980 -a total of 169 patients underwent PTCA at the University Hospital of Zurich. All of them suffered from symptomatic coronary artery disease despite adequate drug therapy with nitrates, ,B-blockers, and calcium antagonists. As a prerequisite, they were accepted for and agreeable to bypass surgery. Table I shows the in-hospital complications, measures, and triage of these 169 consecutive patients. Nine patients (5%) were not available for follow-up exercise tests for reasons explained below. Table 2 lists some general characteristics of the remaining 160 patients constituting our study group. Successful PTICA. Primary success according to the National Heart, Lung and Blood Institute definition (reduction of degree of diameter narrowing by Ba 20%)16 and improvement of symptoms were achieved in 134 patients (80%). Of these 134 patients 62 (46%) remained on antianginal drug therapy. This figure subsequently increased to 58%. Recurrences occurred in 35 patients (26%) 1 to 9 months (mean 5 months) after PTCA. These were evidenced, in all cases, by angiographically measured loss of >50% of initial diameter gain and, in most cases, by conversion of stress test results from negative to positive and recurrence of previously abolished symptoms. Sixteen patients were redilated with lasting success and 16 underwent CABG CIRCULATION 796 by gest on O cber 5, 2017 http://ciajournals.org/ D ow nladed from THERAPY AND PREVENTION-PTCA TABLE 1 Complications, measures, and triage during initial hospitalization of 169 patients undergoing PTCA Successful Failed PTCA PTCA