Southwestern Internal Medicine Conference: Percutaneous transluminal coronary angioplasty

Percutaneous transluminal coronary angioplasty appears to be an effective alternative to coronary artery bypass surgery in patients whose coronary artery anatomy is suitable - that is, an individual with single (or, at most, double) vessel coronary artery disease whose stenoses are proximal, discreate, subtotal, concentric and noncalcified. Since emergent coronary artery bypass surgery is required in 5% to 7% of patients even when angioplasty is attempted by an experienced physician, the patient should be an acceptable candidate for surgery from both a cardiac and noncardiac standpoint. Unfortunately, ideal angioplasty candidates are a distinct minority among those with coronary artery disease. If the procedure is reserved for ideal (or nearly ideal) candidates, the rate of success should approach 75% to 80%, and the incidence of major complications should be below 10%. Although the procedure appears to be effective in alleviating angina, it is unlikely that it will exert a beneficial effect on survival when compared to either medical therapy or coronary artery bypass surgery.