Abstract

Aims This study reports the clinical outcome, up to 17 years, of the first 856 consecutive patients treated by coronary angioplasty at a single centre and attempts to identify a subgroup of patients at low risk of adverse events.

Methods and Results Follow-up status was established via hospital and general practitioner records and the civil registry. Median follow-up was 16 years. The overall 5-, 10-, 15- and 17-year survival was 90%, 78%, 64% and 58%, respectively and corresponding event-free survival was 53%, 33%, 22% and 19%. After 32% of patients had experienced a major adverse cardiac event in the first year, the annual coronary re-intervention incidence thereafter and, even beyond year 10, remained at 2%–3%. Using multivariable Cox regression, significant independent predictors of mortality were advanced age, diabetes, multivessel disease and impaired left ventricular function at the time of PTCA. A subgroup of 26% of the patients with none of these risk factors had a survival rate similar to the general Dutch population matched for age and gender (at 5 years: 96%, at 10 years: 89% and at 15 years: 83%).

Conclusion Although the majority of patients (>80%) experienced a further cardiac event during the 17 years after their first angioplasty procedure, in those non-diabetics under 60 years with single-vessel disease and good left ventricular function, prognosis was similar to the general population.

f1
Correspondence: Ron T. van Domburg, University Hospital Rotterdam Dijkzigt, Thoraxcenter, Location 5 Midden, Room H 539, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.

References

1
Gruentzig
A
. Transluminal dilatation of coronary artery stenosis (letter).
Lancet
 .
1978
;
1
:
263
2
Gruentzig
AR
, Senning A, Sieganthaler WE. Nonoperative dilatation of coronary-artery stenosis: percutaneous transluminal coronary angioplasty.
N Engl J Med
 .
1979
;
301
:
61
–67
3
Talley
JD
, Hurst JW, King SB 3rd. Clinical outcome 5 years after attempted percutaneous transluminal coronary angioplasty in 427 patients.
Circulation
 .
1988
;
77
:
820
–829
4
King
SB
3rd
, Schlumpf M. Ten-year completed follow-up of percutaneous transluminal coronary angioplasty: the early Zurich experience.
J Am Coll Cardiol
 .
1993
;
22
:
353
–360
5
Dorros
G
, Iyer S, Mathiak LM, Anderson AJ. The impact of balloon angioplasty of coronary artery and/or vein bypass graft lesion(s) upon the survival of patients > or =5 years after their last bypass surgery.
Eur Heart J
 .
1993
;
14
:
1354
–1364
6
Kelsey
SF
, James M, Holubkov AL, Holubkov R, Cowley MJ, Detre KM. Results of percutaneous transluminal coronary angioplasty in women, 1985–1986 National Heart, Lung, and Blood Institute's Coronary Angioplasty Registry.
Circulation
 .
1993
;
87
:
720
–727
7
Wilson
WS
, Stone GW. Late results of percutaneous transluminal coronary angioplasty of two or more major native coronary arteries.
Am J Cardiol
 .
1994
;
73
:
1041
–1046
8
Keelan
ET
, Nunez BD, Grill DE, Berger PB, Holmes DR Jr, Bell MR. Comparison of immediate and long-term outcome of coronary angioplasty performed for unstable angina and rest pain in men and women.
Mayo Clinic Proceedings
 .
1997
;
72
:
5
–12
9
Bentivoglio
LG
, Detre K, Yeh W, Williams DO, Kelsey SF, Faxon DP. Outcome of percutaneous transluminal coronary angioplasty in subsets of unstable angina pectoris, A report of the 1985–1986 National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry.
J Am Coll Cardiol
 .
1994
;
24
:
1195
–1206
10
Weintraub
WS
, King SB III, Douglas JS, Kosinski AS. Percutaneous transluminal coronary angioplasty as a first revascularization procedure in single-, double- and triple-vessel coronary artery disease.
J Am Coll Cardiol
 .
1995
;
26
:
142
–151
11
Ruygrok
PN
, de Jaegere PP, van Domburg RT, van den Brand MJ, Serruys PW, de Feyter PJ. Clinical outcome 10 years after attempted percutaneous transluminal coronary angioplast in 856 patients.
J Am Coll Cardiol
 .
1996
;
27
:
1677
–1699
12
Hasdai
D
, Bell MR, Grill DE. Outcome >10 years after successful percutaneous transluminal coronary angioplasty.
Am J Cardiol
 .
1997
;
79
:
1005
–1011
13
Halon
DA
, Flugelman MY, Merdler A, Rennert H, Shahla J, Lewis BS. Long-term (10-year) outcome in patients with unstable angina pectoris treated by coronary balloon angioplasty.
J Am Coll Cardiol
 .
1998
;
32
:
1603
–1609
14
Kimura
T
, Yokoi H, Nakagawa Y. Three-year follow-up after implantation of metallic coronary-artery stents.
N Engl J Med
 .
1996
;
334
:
561
–566
15
de Jaegere
PPT
, de Feijter PJ, van Domburg R. Immediate and long-term results of percutenous coronary angioplasty in patients aged 70 and over.
Br Heart J
 .
1992
;
67
:
138
–143
16
N Engl J Med
 .
1996
;
335
:
217
–225
17
Henderson
RA
, Pocock SJ, Sharp SJ. Long-term results of RITA-1 trial: clinical and cost comparisons of coronary angioplasty and coronary-artery bypass grafting. Randomised Intervention Treatment of Angina.
Lancet
 .
1998
;
352
:
1419
–1425
18
Veldkamp
RF
, Meeter K, Valk SDA, van Domburg RT, van Herwerden LA, Bogers AJJC. Mortality and repeat interventions until 20 years after aorto-coronary bypass: a follow-up study of 1041 patients.
Eur Heart J
 .
2000
;
21
:
747
–753
19
J Am Coll Cardiol
 .
2000
;
35
:
1122
–1129

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