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Percutaneous transluminal coronary angioplasty (PTCA), a therapeutic technique that uses balloon dilation to open up narrow sections of diseased coronary arteries, can be an alternative to coronary artery bypass surgery (CABG). A retrospective study of the medical records of 90 patients who underwent PTCA for a totally occluded artery was performed to evaluate the frequency of major complications due to PTCA. None of the occlusions were considered to be a complication of heart attack or restenosis. After further review, the 90 patients were subdivided into a stable angina (44 patients) or an unstable angina group (46 patients). Angina (pectoris) is a steady, severe pain with a feeling of pressure in region of the heart; the pain usually travels to the left shoulder down the left arm. It is caused by insufficient blood supply to the heart. For this study, unstable angina was categorized as progressive angina, angina at rest, or early angina after infarction. The two groups averaged 56 years of age and the majority of subjects were men. The occurrence of major complications such as embolization, reocclusion during PTCA, coronary intimal dissection, and occlusion of the side arteries was more frequent in patients with unstable angina (about 20 percent) than for those with stable angina (2.5 percent). The only significantly different observation was reocclusion during PTCA, which only happened in unstable angina patients (17 percent). Limitations of this study include the fact that (1) a relatively low number of patients were evaluated; (2) the age of the occlusion may not correlate with duration of patients symptoms, and (3) the sensitivity of angioplasty may be low compared with angioscopy and histopathology observations, making it possible that the frequency of blood clots were underestimated. PTCA is regarded as a safe and effective procedure to treat a totally occluded coronary artery, but this study suggests that patients with unstable angina represent a high-risk subgroup who might be better off with a different treatment approach such as thrombolytic therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

At first glance it might seem that a completely blocked coronary artery must lead to the death and necrosis of the area of heart muscle supplied by that artery. But this is not necessarily the case, as there is some degree of overlap of coronary circulation. If the area supplied by the blocked artery is not large, the tissue oxygen demand may be satisfied by a collateral artery. However, under conditions of increased oxygen demand, this partial blood supply may no longer be adequate, and symptoms of ischemia (inadequate oxygen supply) may develop. PTCA, or percutaneous transluminal coronary angioplasty, may be used to open totally occluded arteries as well as those only partially blocked. PTCA has a success rate over 90 percent in partially occluded arteries; the success rate is roughly 60 percent for totally occluded arteries. The duration of time in which the occlusion has existed is a major determinant of PTCA success, and the chances of success are substantially reduced if the occlusion is older than two months. The length of the occluded segment is also significant; a 78 percent success rate has been reported for segments less than 1.5 centimeters, but it falls to 42 percent for longer segments. In addition, occlusions in straight segments are more amenable to PTCA than are those in curved segments. Although there are serious potential complications of PTCA for totally occluded arteries, there is no evidence that they are any worse than the complications of PTCA for partially occluded arteries. However, restenosis, or recurrence of arterial narrowing after PTCA, is more frequent among totally occluded arteries, occurring roughly 40 percent of the time, in contrast to a restenosis rate of 30 percent for partially occluded arteries treated by PTCA. (Consumer Summary produced by Reliance Medical Information, Inc.)

Aim: Public reporting of procedural outcomes leads to risk averse behavior because physicians do not believe the scores account for patient risk. We investigated the effects of more aggressive percutaneous coronary intervention (PCI) practice on risk-adjusted mortality. Methods & results: 8935 PCI were performed. Risk adjustment was performed with the New York State PCI risk score. The cohort was divided into two eras based on programs implemented to promote more aggressive care. Between eras, overall adjusted mortality ratios rose from 0.66 to 0.90 (observed/predicted, p = 0.02), despite evidence supporting consistent procedural quality. Conclusion: Evidence-based changes in PCI practice were associated with worsening risk-adjusted procedural mortality. These data are consistent with physician beliefs regarding risk-adjusted outcome measures. [ABSTRACT FROM AUTHOR]

Background: Previous studies suggest that the clinical presentation of acute coronary syndromes (ACS) may differ between women and men. It is not known if different clinical presentations may be explained by hormonal status in women with ACS. Our objective was to compare the clinical presentation of ACS between premenopausal (PRE) women and post- menopausal women with hormone replacement therapy (HRT) and without (POST). Methods: This was a prospective study of consecutive women admitted with a diagnosis of ACS (myocardial infarction [MI] or unstable angina). All women answered a detailed questionnaire that included a list of 27 clinical symptoms. Symptom results were adjusted for age and current coronary event diagnosis. Results: Seventy-three Caucasian women were studied. No differences were found in terms of the frequency of reported typical symptoms of ACS between PRE (n = 23), HRT (n = 32), and POST (n = 18). However, PRE more often reported atypical chest symptoms than HRT and POST women (57% vs. 31% vs. 22%, PRE vs. HRT vs. POST, respectively, p = 0.05). HRT and POST women experienced substernal chest pain more frequently than PRE (44% vs. 78% vs. 83%, p = 0.03). In contrast, PRE more frequently tended to experience chest pressure (57% vs. 31% vs. 39%, p = 0.2) or chest pain in other locations (22% vs. 3% vs. 6%, p = 0.06). HRT and POST groups reported more frequent indigestion-like pain/discomfort (22% vs. 50% vs. 56%, p = 0.04) and midback pain (35% vs. 63% vs. 72%, p = 0.04) during ACS compared with PRE women. POST experienced sudden fatigue more frequently than PRE and HRT (61% vs. 53% vs. 89%,p = 0.03). Conclusions: Our results suggest that almost all women admitted with ACS experienced typical chest symptoms but frequently reported both typical and atypical symptoms. Independently of age, atypical chest symptoms occurred more frequently in premenopausal women than in postmenopausal women with or without HRT. [ABSTRACT FROM AUTHOR]