Percutaneous coronary revascularization in patients with formerly "refractory angina pectoris in end-stage coronary artery disease" - not "end-stage" after all

• Published in: BMC cardiovascular disorders 2009-08, Vol.9 (1), p.42-42, Article 42
• Main Authors: Jax, Thomas W, Peters, Ansgar J, Khattab, Ahmed A, Heintzen, Matthias P, Schoebel, Frank-Chris
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Angina pectoris; Angina Pectoris - etiology; Angina Pectoris - mortality; Angina Pectoris - surgery; Angina Pectoris - therapy; Angioplasty, Balloon, Coronary - adverse effects; Angioplasty, Balloon, Coronary - mortality; Cardiovascular system; Care and treatment; Coronary Angiography; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - mortality; Coronary Artery Disease - complications; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary Artery Disease - surgery; Coronary Artery Disease - therapy; Coronary heart disease; Diagnosis; Feasibility Studies; Female; Humans; Male; Middle Aged; Patient Selection; Recurrence; Retrospective Studies; Severity of Illness Index; Surgery; Time Factors; Treatment Outcome
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/1471-2261-9-42

Patients with refractory angina pectoris in end-stage coronary artery disease represent a severe condition with a higher reduction of life-expectancy and quality of life as compared to patients with stable coronary artery disease. It was the purpose of this study to invasively re-evaluate highly symptomatic patients with formerly diagnosed refractory angina pectoris in end-stage coronary artery disease for feasible options of myocardial revascularization. Thirty-four patients formerly characterized as having end stage coronary artery disease with refractory angina pectoris were retrospectively followed for coronary interventions. Of those 34 patients 21 (61.8%) were eventually revascularized with percutaneous interventional revascularization (PCI). Due to complex coronary morphology (angulation, chronic total occlusion) PCI demanded an above-average amount of time (66 +/- 42 minutes, range 25-206 minutes) and materials (contrast media 247 +/- 209 ml, range 50-750 ml; PCI guiding wires 2.0 +/- 1.4, range 1-6 wires). Of PCI patients 7 (33.3%) showed a new lesion as a sign of progression of atherosclerosis. Clinical success rate with a reduction to angina class II or lower was 71.4% at 30 days. Surgery was performed in a total of8 (23.5%) patients with a clinical success rate of 62.5%. Based on an intention-to-treat 2 patients of originally 8 (25%) demonstrated clinical success. Mortality during follow-up (1-18 months) was 4.8% in patients who underwent PCI, 25% in patients treated surgically and 25% in those only treated medically. The majority of patients with end-stage coronary artery disease can be treated effectively with conventional invasive treatment modalities. Therefore even though it is challenging and demanding PCI should be considered as a first choice before experimental interventions are considered.