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Submitted: 07 July 2008 Modified: 21 April 2017
HERDIN Record #: PCHRD070908020710

Percutaneous transluminal coronary angioplasty in the young. In-hospital outcomes and their predictors: The Philippine Heart Center experience (A 10-Year Review).

Gerald C. Vilela,
Daniel A. Dino

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Background ÃÆ'Æ'Æ’ÃÆ'†â€™ÃÆ'Æ'â€Ã...¡ÃÆ'‚¢ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ This study was performed to review the in-hospital outcome and their predictors of percutaneous transluminal coronary angioplasty in patients less than 40 years of age, and to identify the risk factors involved in premature coronary artery disease.

Methods and Results ÃÆ'Æ'Æ’ÃÆ'†â€™ÃÆ'Æ'â€Ã...¡ÃÆ'‚¢ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ Patients undergoing percutaneous transluminal angioplasty were retrospectively analyzed and entered into a database. Clinical and angiographic data on all patients aged less than 40 years were reviewed. Follow up data (in-hospital outcome) were gathered by comprehensive review of the hospital charts. Seventy-four patients aged less than 40 years (mean 35, range 27-39) underwent coronary angioplasty because of history of myocardial infarction (51 patients: 18 AMI, 33 Post-lnfarct Angina), stable angina (15 patients), unstable angina (5 patients), arrhythmia (2 patients), sudden cardiac death (1 patient). Males comprised the majority of the patients (92 percent). Smoking is still the most common risk factor (78 percent) for males while a family history of CAD is the most common risk factor (67 percent) for females. The initial angiographic success rate (TIMI 3 flow or attainment of residual diameter stenosis <50 percent) was 91.5 percent in a total of 117 lesions attempted. A major procedure related complication occurred in 6 patients (8.1 percent): 5 vascular injuries ( 2 intimal dissections, 3 significant hematoma), 1 developed acute renal failure post-procedurally. Three patients (4 percent) died: 2 had acute massive anterior wall Ml and 1 from recurring thrombus formation in the left main coronary artery despite intracoronary thrombolysis. Univariate analysis showed that the use of balloon angioplasty alone was the only predictive factor for morbidity (p<0.005) while hypertension (p<0.02), concomitant infection (p<0.04), incomplete revascularization (p<0.02), left main coronary artery involvement (p<0.04), and cardiogenic shock / high risk NSTEMI (p<0.001) as the clinical setting for PTCA were the predictive factors for mortality. The overall morbidity / mortality were 12 percent.

Conclusion ÃÆ'Æ'Æ’ÃÆ'†â€™ÃÆ'Æ'â€Ã...¡ÃÆ'‚¢ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ Smoking is the most common risk factor for premature coronary artery disease (< 40 years of age). In this age group, coronary angioplasty had a high immediate success rate with an acceptable morbidity and mortality. Coronary angioplasty in young patients can be considered as a safe therapeutic procedure for symptomatic CAD, both electively and as direct therapy for acute myocardial infarction. (Author)

Publication Type
Journal
Publication Sub Type
Announcements
Title
Philippine Heart Center Journal
Frequency
Quarterly
Publication Date
April-June 2006
Volume
12
Issue
3
Page(s)
1-8

Objectives

It is conceivable that some factors may affect coronary heart disease and its treatment differently in premature vs. delayed onset of disease. The primary objective of this investigation was to identify in-hospital outcomes and its predictors after contemporary PTCA in young adult patients. Subsequently we aim to identify the correctable risk factors predisposing to premature atherosclerosis and to characterize the epidemiology, clinical, and angiographic profile of patients with premature (<40 years of age) coronary artery disease undergoing PTCA.

LocationLocation CodeAvailable FormatAvailability
Philippine Council for Health Research and Development Library Abstract Print Format (Request Document)
Philippine Heart Center Medical Library Fulltext Print Format (Request Document)

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