Hecht, Harvey S.

Myler, Richard K.

Shaw, Richard E.

Stertzer, Simon H.

Elsevier - Publisher Connector 

266A ABSTRACTS JACC Vol. 17. No. 2 February 1991:266A 
Wednesday, March 6, 1991 
played: 9:00AM-12:OONOON 
esent: 1 l:OOAM-12:OONOON 
all F, West Concourse 
Balloon Angioplasty: Factors Influencing Early and 
Late Results 
LONS TE RISK/BENEFIT OF PTCA OF INFARCT RELATED 
VESSEL. 
Eric Tisor\, Antoine Gommeaux, Jean M. Lablanche, 
Christophe Bauters, Fabrice Leroy, Michel E. Bertrand. 
University of Lille. Lille, France 
The goal of this study was to determine the 6 mth 
results of successful PTCA of an infarct related vessel 
(IRV) and their influence on LV function at rest. We 
studied 204 pts with MI, (193 M, 11 F), mean age 51 yrs. 
144 had thron?bolysis within 4 hours of MI and 60 
received conventional treatment. All had successful PTCA 
of IRV. They were restudied 6 mths later. All pts 
undement LV cineangiography before PTCA and at 6 mths 
FU. LVED volume, EF, and segmental wall motion (SWM) 
were calculated. Restenosis was defined as the 
recurrence of >SOX stenosis. 
1) PTCA of the IRV was followed 6 mths later by a 
relatively high rate of restenosis or reocclusion. 
Thrombolysed MI 
No restenosis 80 
Rojn2Thrombolysed MI 
Restenosis 
Re-occlusion :: 46% :i 47% 
2) There were no significant changes of LV function in 
inferior or lateral MI and non thromboiysed anterior MI 
whatever the status of IRV. 
3) However, in thrombolysed anterior MI, a sustained 
satisfactory result of IRV dilation prevented LV 
dilatation and improved segmental anterior ~~~n;;~ion. 
LVEOV (ml/m2) Before PTCA 
No restenosis 87.5+/-27.4 88.2+/-24.7 
Restenosis 78.8+/-20.5 g6.6t/-3018 
Re-occlusion 80.7t/-24.6 lOO.l+/-50.4 
Conclusion:Restenosis or reocclusion have few effects on 
LV function of inferior/lateral MI but are accompanied 
by LV dilation in thrombolysed anterior MI. 
SILENT VERSUS PAINFUL XSCHEHIA AFTER CORONARY 
ANGIOPLASTY: COHPARISON OF AMOUNT AND SEVERITY OF 
ISCtilSMIC MYOCARDIUM SECONDARY TO RESTRNOSIS BY 
TOMOGRAPHIC THALLIUM-201 EXERCISE IMAGING 
Harvey S. Hecht, Richard E. Shew, Simon H. Stertze:, -- 
Richard K. Myler. San Francisco Heart Institute, Seton 
Medical Center, Daly City, CA 
To compare the amount and severity of jeopardized 
myocardium resulting from silent ischemia (SI) vs 
painful ischemia (PI) after coronary angioplasty 
(PTCA), 25 Pts without angina with restenosis (RES) in 
30 vessels ‘V) and 44 pts with angina and RES in 55 V 
underwent tomographic thallium-201 exercise and 
redistribution imaging (SPECT) 6.4 months after PTCA. 
The SPECT images were divided into 20 segments (SEG) 
scored on a O-4 scale (from normal to severe 
ischemia). Each stenotic V was assigned a SPECT 
severity score Equal to the sum of scores of the 
ischemic segments in its distribution. 
RESULTS: 1 SI I PI 
I Ischemic (Severity 1 Ischemic ISeverity 
IV(~) sEG/v 1 Score/V 1 V(n) SEG/V I Score/V 
LAD 1 14 7.6 919.8 
‘12.0 
1 30 7.6 21.1 
RCA 1 10 5.3 i 14 3.7 9-i 
LCX 1 6 3.5 8.3 i 11 2.3 5.9 
p=n.s. for all vessels SI vs PI 
Percent diameter of RES for SI vs 21 was 76.1 vs 80.5 
[p=n.s.). In conclusion, silent and painful ischemia 
secondary to RES after PTCA are associated with equal 
amor:,,ts and severity of ischemic myocardium and eg:.al 
diameter RES. 
REDUCTION DURING CORO 
A PROSPECTIVE INVESTIGATION 
Kenneth G. Lehmann, Jashu3 H3. Feuo:, #rxai?th 8. Ku~marn~t~, and 
f-la . Le. Long Beach 
The contribution of repeated balloon inflations to the effectiveness of 
coronary stenosis dilation is unclear. In this prospective study, 78 lesions 
were subjected to stepwise inflations using noncompliant balloon systems 
at 2,3,4,6,8, and 10 atm. All patients received two such inflations, and 
22 (26%) a third inflation. Using the centerline method, absolute stenosis 
diameters were derived from the lesion’s pattern of indentation upon the 
balloon during each inflation stage. The mean balloon-to-artery ratio was 
1 .OO + 0.20 [SD]. During the first inflation, minimal diameter from Stage 1 
to Stage 6 increased 
from 1 SO -C 0.53 mm to rlrnomic dbmolmf (0 mnn Mlbm dim) r~sr - -.------ - -- 
2.72 + 0.47 mm (p < 
0.0001). corresponding Iw Y- - 
to a rklative stenosis 
decrease from 46% to 
7%. However, at the 
initiation of subsequent a~ 
in!lations, stenosis 
diameter was not 
greatly different than at 401 
the termination of the ’ ’ I) 0 1klbll Dm-dmurm Im ) 
to b 
first inflation (2.72 vs 
2.46 vs 2.46 mm for 1 st, 2nd & 3rd). Moreover, second a?d tkrd inflations 
did not improve stenosis severity (93% vs 94% vs 93% respectively; ipns). 
These data suggest that during PTCA, all significant gains in luminal area 
occur with the first inflation, and that subsequent inflations at the same 
pressure offer no further improvement. Thus, the routine use of mukiple 
inflations may prolong the procedure without improving the results. 
Barry D. Rutherford, David R. McConahay, 
Warren L. Jihnson, Lee V. Giorgi, Robert W. Ligon, 
Geoffrey 0. Hartzler. Mid America Heart Institute, Kansas 
City, Missouri. 
In order to examine the reported increased mortal risk of 
percutaneuus transluminal coronary angiop9asty (PTCA) in 
women, the acute results and complications of elective 
PTCA in 2033 women and 7142 men treated in the last IO 
years were compared. Women were older than men 
(64flO vs 59flO years, pc.OOl), and more frequently had 
Class IV angina (53% vs 36%, p<.OOl) and diabetes 
mellitus (23% vs 12%, p<.OOl). There were similar 
numbers of women and men with LV ejection fractions 
s40% (9.2% vs 9.7%, p=NS), but fewer women had 3 
vessel disease (3094 vs 37%, pc.OOl), prior coronary 
bypass (17% vs. 25%, pc.OOl), or left main disease (1% 
vs 2%, p=.OO2). PTCA was successful in 95% of stenoses 
dilated in both women and men. The procedural risks in 
women and men of emergency bypass (1.6% vs 1.6%), 
and Q-wave infarction (1.7% vs 1.4%) were comparable, 
but death due to PTCA was more frequent in women (1.4% 
vs O.B%, p=.Ol). Using multivariate analysis, adjustment 
for the increased age and angina1 symptoms of women 
accounted for all of the difference in mortality between 
women and men, and PTCA in women was not picked as 
an independent predictor of mortality. These observations 
suggest that earlier identification and referral of women 
withcoronary artery disease might improve their results 
with PTCA. 


Silent versus painful ischemia after coronary angioplasty: Comparison of amount and severity of ischemic myocardium secondary to restenosis by tomographic thallium-201 exercise imaging 

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Silent versus painful ischemia after coronary angioplasty: Comparison of amount and severity of ischemic myocardium secondary to restenosis by tomographic thallium-201 exercise imaging

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