Intracoronary thrombolysis in acute myocardial infarction: clinical course following successful myocardial reperfusion.

We reviewed the clinical course of 73 patients who had attempted intracoronary thrombolysis, with emphasis on follow-up. Fifty-nine patients (81%) had coronary reflow sufficient to control pain and injury current: 52 received thrombolysis alone and seven had thrombolysis combined with acute coronary angioplasty. Recurrent ischemic events in hospital were frequent and occurred in 17 patients (29%).

Restenosis after percutaneous transluminal coronary angioplasty (PTCA): a report from the PTCA Registry of the National Heart, Lung, and Blood Institute.

The results of follow-up angiography in patients from 27 clinical centers enrolled in the PTCA Registry were analyzed to evaluate restenosis after PTCA. Of 665 patients with successful PTCA, 557 (84%) had follow-up angiography (median follow-up 188 days). Restenosis, defined as an increase of at least 30% from the immediate post-PTCA stenosis to the follow-up stenosis or a loss of at least 50% of the gain achieved at PTCA, was seen in 187 patients (33.

Effect of investigator experience on percutaneous transluminal coronary angioplasty.

The NHLBI PTCA Registry collected clinical data on 3,101 PTCA procedures performed at 105 clinical centers between September 1977 and September 1981. To investigate the "learning curve" from introduction through the early application of this new therapy for revascularization, success rates and complication rates were examined by calendar year and according to investigator experience. Success rates improved by calendar year, from 54% in 1979 to 66% in 1981.

Relative cost of coronary angioplasty and bypass surgery in a one-vessel disease model.

A national study was carried out to determine the relative costs of PTCA and CABG. Baseline clinical criteria for the 2 groups were similar. Data were collected in 186 sets for the PTCA group and 175 sets for the CABG group.

Return to work after coronary angioplasty: a report from the National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry.

Employment status was analyzed in 2,250 patients enrolled at 65 clinical centers in the NHLBI PTCA Registry. Patients were classified into 3 groups depending on the outcome of PTCA. In 63.

Long-term efficacy of percutaneous transluminal coronary angioplasty (PTCA): report from the National Heart, Lung, and Blood Institute PTCA Registry.

The NHLBI PTCA Registry has collected data from 3,079 patients who underwent PTCA at 105 centers from September 1977 through September 1981 that document the initial risks and benefits of PTCA. A subgroup of 2,272 patients at 65 centers was chosen to examine the long-term effects of PTCA (97% follow-up). All patients were followed for 1 year, 191 for 3 years and 57 for 4 years.

Emergency coronary bypass surgery after coronary angioplasty: the National Heart, Lung, and Blood Institute's Percutaneous Transluminal Coronary Angioplasty Registry experience.

The frequency and outcome of emergency CABG for complications of PTCA in the NHLBI PTCA Registry were analyzed. Emergency surgery was performed in 202 patients (6.6%).

In-hospital mortality rate in the National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry.

Twenty-nine patients died among the first 3,079 patients enrolled in the NHLBI PTCA Registry. The overall morality rate was 0.9%; the mortality rate was 0.

Role of percutaneous transluminal coronary angioplasty in the treatment of unstable angina. Report from the National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty and Coronary Artery Surgery Study Registries.

The acute and long-term consequences of PTCA performed in patients with unstable angina was determined in 442 patients with 1-vessel CAD who were enrolled in the NHLBI PTCA Registry. These patients were compared with 214 similar patients in the PTCA Registry with stable angina and with 330 patients with unstable angina from the NHLBI CASS Registry who underwent CABG. The 3 groups had similar baseline characteristics.

Complex coronary angioplasty: multiple coronary dilatations.

Selected patients underwent PTCA of multiple stenoses in different vessels or in the same vessel. Three hundred nine patients underwent 685 PTCA procedures in various combinations of arterial and vein graft stenoses. A multiple dilatation procedure was defined as successful when all lesions attempted were successfully dilated, or when the considered-critical-stenosis was successfully dilated and this resulted in a patient clinical improvement.

Combined intracoronary streptokinase infusion and coronary angioplasty during acute myocardial infarction.

PTCA was performed in 28 patients with acute MI immediately after intracoronary streptokinase administration. Indications were failure to obtain reflow in 16 patients and high-grade residual stenosis in 12. PTCA was successful in 11 of 16 cases of streptokinase failure, increasing the overall reflow rate from 66% to 77%.

Acute coronary events associated with percutaneous transluminal coronary angioplasty.

Acute coronary events reported in patients enrolled in the NHLBI PTCA Registry were analyzed. Data were collected on 3,079 patients from 105 contributing centers. Coronary vascular events (dissection, occlusion, spasm, embolism, perforation or rupture) or ischemic events (MI or prolonged angina) occurred in 418 patients (13.

Impedance cardiograms reliably estimate beat-by-beat changes of left ventricular stroke volume in humans.

Linear regression was used to compare stroke volumes calculated from tetrapolar impedance cardiograms and simultaneous left ventriculograms in 14 patients undergoing diagnostic left heart catheterisation. We calculated three to five consecutive stroke volumes from each ventriculogram. Left ventricular stroke volumes estimated by the two methods correlated closely: the correlation coefficients from pairs of data obtained from individual patients ranged between 0.

Angiographic diagnosis of posterior mitral valve leaflet prolapse.

The left ventricular cineangiograms of 22 asymptomatic, apparently healthy male aviators without noninvasive (echocardiographic or auscultatory) evidence of mitral valve prolapse were reviewed and compared with those of 12 men with noninvasive evidence of mild mitral valve prolapse. The maximal protrusion of the posterior mitral valve leaflet superior and posterior to a line perpendicular to the long axis of the left ventricle at end-systole was measured from the right anterior oblique left ventricular cineangiogram by repeated observation of left ventricular inflow. The values were 7.

Percutaneous angioplasty of stenoses of bypass grafts or of bypass graft anastomotic sites.

Forty patients who had stenoses of coronary artery bypass grafts or stenoses of the proximal or distal coronary insertion sites were treated with percutaneous transluminal angioplasty (PTA). PTA was successful in 78% of the patients. Mean stenoses were diminished from 86% to 34% in luminal diameter.

Regional and systemic thrombolytic therapy in acute myocardial infarction.

Thrombolytic therapy has emerged as a promising approach in the management of patients with acute myocardial infarction. Intracoronary infusion can achieve patency in a high percentage of patients with evolving transmural infarction, and recent preliminary evidence indicates that reperfusion may also be achieved in a substantial but lower percentage of patients with intravenous administration. The relative safety and the efficacy in restoring flow in selected patients seem established, and there is considerable evidence that successful thrombolysis with early reperfusion is associated with salvage of ischemic myocardium as determined by improvement in left ventricular function and by myocardial perfusion imaging.

Aneurysms of the left main coronary artery: a report of three cases and review of the literature.

Coronary artery aneurysms have been reported to occur in 1-2% of most large angiographic series. However, aneurysms of the left main coronary artery (LMCA) are extremely rare. Only eight previous cases of LMCA aneurysms have been reported, and only one of these cases was felt to be atherosclerotic in etiology.

Employment and recreation patterns in patients treated by percutaneous transluminal coronary angioplasty: a multicenter study.

Employment and recreational patterns were analyzed in 279 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) for treatment of symptomatic coronary artery disease. PTCA was successful in 180 patients (65%). When it was unsuccessful, coronary artery bypass graft surgery was usually performed (80%).

Methodologic aspects of intracoronary thrombolysis. Drugs, dosage and duration.

Clinical experience indicates that the methods of intracoronary thrombolysis are not standardized. Although overall reperfusion rates of 75-80% have been achieved, clinical application at individual centers reflects variations in thrombolytic agents used, dosage, infusion rates, technique of administration and use of adjunctive measures, as well as variation in rates of successful recanalization. Analysis of results as a function of differences in approach suggests that certain procedural factors may influence reperfusion rates.

Fibrinolytic effects of intracoronary streptokinase administration in patients with acute myocardial infarction and coronary insufficiency.

Serial coagulation studies were obtained in 25 patients treated with intracoronary streptokinase infusion for myocardial infarction (23 patients) or coronary insufficiency (two patients) to determine the frequency of systemic fibrinolytic activity. Clotting studies were obtained before and after infusion and at 4-hour intervals until normalization. Intracoronary thrombolysis was successful in 20 of 23 patients (87%) with myocardial infarction.

Percutaneous transluminal coronary angioplasty: report of complications from the National Heart, Lung, and Blood Institute PTCA Registry.

The complications reported in the first 1500 patients enrolled in the National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty (PTCA) Registry are analyzed. Data were contributed from 73 centers between September 1977 and April 1981. PTCA was successful in 63% of attempts.

Intracoronary thrombolysis in syndromes of unstable ischemia: angiographic and clinical results.

For an assessment of association of intracoronary thrombus with prolonged unstable myocardial ischemia and of the possible efficacy of local thrombolysis, 12 patients with recent prolonged unstable angina underwent 13 intracoronary streptokinase infusions. All patients had prolonged rest angina within 5 days of coronary angiography. Abnormal resting ECGs were present in all patients, and 10 had ECG changes referable to the ischemic-related vessel.

Percutaneous transluminal coronary angioplasty: report from the Registry of the National Heart, Lung, and Blood Institute.

Data have been collected from 34 centers in the United States and Europe performing percutaneous transluminal coronary angioplasty since September 1977. The procedure was carried out in 631 patients, with an average age of 51 years (range 23 to 76), of whom 80 percent had single vessel coronary disease, 17 percent had double or triple vessel disease and 3 percent had stenosis of the left main coronary artery. Coronary angioplasty was successful (greater than 20 percent decrease of coronary stenosis) in 59 percent of the stenosed arteries.