CORONARY ANGIOPLASTY FOR MEDICALLY REFRACTORY UNSTABLE ANGINA IN PATIENTS WITH PRIOR CORONARY-BYPASS SURGERY

Percutaneous transluminal coronary sngioplasty (PTCA) has been applied with good results to selected patients with unstable angina and to selected patients who have had prior bypass surgery. The population with prior bypass and unstable angina has not been specifically evaluated. This report reviews the results of angioplasty of 45 vessels in 34 patients with medically refractory unstable angina and at least one prior bypass heart surgery. Of these 34 patients, 32 had rest angina; 14 had resting electrocardiographic changes, all 34 were on aspirin 325 mg QD, 31 were on a calcium blocker. 22 were on a beta blocker, 9 were on intravenous nitroglycerin, and 5 required intraaortic balloon counterpulsation for temporary stabilization. Angioplasty of a vein graft was attempted in 17 patients; the left internal mammary was attempted in 4 patients; 24 native coronary arteries in 15 patients were attempted; 3 of the native arteries were protected left main arteries. Of the LIMA angioplasties, 3 were successful; in the 1 unsuccessful case, the occluded anterior descending artery was opened. Of the 17 vein grafts, 16 were successful: 1 had an acute occlusive syndrome and went to surgery with a balloon pump and bail out catheter; his recovery was uneventful. Of the 24 native artery angioplasties, 22 were successful: one patient was technically unsuccessful in the only vessel attempted; he went to semiemergent surgery and recovered uneventfully. In the other, a right coronary lesion was successfully dilated, but an occluded anterior descending artery was not opened. There were no deaths or in‐hospital myocardial infarctions. Of the 32/34 patients with technically successful angioplasty, all 32 had relief of rest angina, and 27 had pre‐discharge exercise testing: 19 were completely asymptomatic and 8 had angina only at maximal exertion. In follow‐up ranging from 6 months to 36 months, 4 patients with vein graft angioplasty, 2 patients with native artery angioplasty, and one of the operated patients, had complications. Two patients with recurrence at 2 months and 14 months, respectively, have undergone successful repeat angioplasty; two patients have had reoperation; 2 patients have had remote myocardial infarctions. Thus far, none of the LIMA have recurred clinically. There have been 2 late deaths in one angioplastied and one operated (the technical failure) patients: one from pulmonary emboli and one from heart failure, both at 6 months after index hospitalization. These data suggest that emergent or semiemergent angioplasty can be performed safely and with good clinical results in patients with unstable angina and prior heart surgery. Copyright © 1990 John Wiley & Sons, Ltd.