Mary C. Murphy

Lesion morphology and coronary angioplasty: Current experience and analysis

From July 1, 1990 to February 28, 1991, 533 consecutive patients with 764 target vessels and 1,000 lesions underwent coronary angioplasty. Procedural success was achieved in 92.3%, untoward (major cardiac) events occurred in 3% (0.8% myocardial infarction, 1.3% emergency coronary bypass grafting and 0.9% both; there were no deaths). An unsuccessful uncomplicated outcome occurred in 4.7%. Lesion analysis using a modified American College of Cardiology/American Heart Association classification system showed that 8% were type A, 47.5% were type B and 44.5% were type C (36% of type B and 11% of type C were occlusions). Angioplasty success was achieved in 99% of type A, 92% of type B and 90% of type C lesions (A vs. B, p less than 0.05; B vs. C, p = NS; A vs. C, p less than 0.01). Untoward events occurred in 1.2% of type A, 1.9% of type B and 2% of type C lesions (p = NS). An unsuccessful uncomplicated outcome occurred in 0% of type A, 6% of type B and 7% of type C lesions (A vs. B, p less than 0.05; B vs. C, p = NS; A vs. C, p less than 0.05). Among the unsuccessful uncomplicated outcome group, occlusion occurred in 49%: 38% of type B and 59% of type C lesions. With B1 and B2 subtypes, success was obtained in 95% and 89.5% and untoward events occurred in 1.5% and 2.3% and an unsuccessful uncomplicated outcome in 3.7% and 8%, respectively. C1 and C2 subtyping showed success in 91% and 86%, untoward events in 1.3% and 6% and an unsuccessful uncomplicated outcome in 7.5% and 8.5%, respectively. Among the 764 vessels, success was obtained in 89.5% and untoward events occurred in 2.5% and an unsuccessful uncomplicated outcome in 8%. Assessment of lesion-vessel combinations showed a less favorable outcome with type C lesions and combinations of A-B, B-C and multiple (more than three lesions) type B and C vessels. Statistical analysis of morphologic factors associated with angioplasty success included absence of (old) occlusion (p less than 0.0001) and unprotected bifurcation lesion (p less than 0.001), decreasing lesion length (p less than 0.003) and no thrombus (p less than 0.03). The only significant factor associated with untoward events was the presence of thrombus (p less than 0.003). Predictors of an unsuccessful uncomplicated outcome included old occlusion (p less than 0.0001) and increasing lesion length (greater than 20 mm) (p less than 0.001), unprotected bifurcation lesion (p less than 0.05) and thrombus (p less than 0.03).

Percutaneous transluminal angioplasty of stenotic coronary artery bypass grafts: 5 years' experience.

In a 60 month period (January 1981 to December 1985), 82 patients (79% male with a mean age of 60 years) had 83 saphenous vein grafts and 5 internal mammary artery grafts with a total of 101 stenotic sites treated with percutaneous transluminal coronary angioplasty. The mean time between bypass surgery and angioplasty was 51.2 months. The procedure was technically successful in 85% of patients, 86% of grafts and 85% of the sites attempted. In these cases, the mean diameter stenosis was reduced from 77 +/- 14 to 27 +/- 20% (p less than 0.001), the mean pressure gradient from 49 +/- 16 to 7 +/- 6 mm Hg (p less than 0.001). Emergency coronary artery bypass graft surgery was necessary in one patient (1.2%) whereas myocardial infarction occurred in three patients (3.6%). There were no hospital deaths. Clinical follow-up was obtained in all 82 patients. Before angioplasty, 23% were in Canadian Cardiovascular Society functional class II, 60% in class III and 17% in class IV. With a mean clinical follow-up period of 21.4 +/- 2.3 months, 71% are in class I, 17% in class II and 12% in class III. There were two deaths, 3 months or more after angioplasty, one probably due to graft closure. So far, angiographic follow-up (at 7.9 +/- 2.1 months) has been available in 26 patients. Ten patients (with 10 grafts) exhibited graft restenosis; six of them have had second successful repeat angioplasty. Among the many variables analyzed, statistically significant predictors of success were a higher measured balloon/graft ratio (p less than 0.001), smaller diameter graft (p less than 0.001), and shorter lesion length (p less than 0.01). The only predictor of complication was diffuseness of disease in the graft (p less than 0.05). The statistically significant predictors of recurrence were the residual stenosis after the initial angioplasty (p less than 0.01) and the measured balloon/graft ratio (p less than 0.01). Angioplasty of coronary artery grafts appears to be a feasible and efficacious procedure with a low complication rate. The technique is a satisfactory alternative to repeat surgery in selected patients.

School-Based Primary Prevention of Depressive Symptomatology in Adolescents Findings from Two Studies

Two school-based primary prevention interventions for adolescent depressive symptomatology and disorder were examined in separate studies with high school samples of 9th and 10th-grade adolescents. In Study 1, a three-session educational intervention was associated with a short-term reduction in extreme-scoring cases of depressive symptoms among boys, but not girls, when compared to a randomly assigned control condition. However, this effect was not sustained over a 12-week follow-up period. In Study 2, a five-session behavioral skills training intervention, failed to demonstrate any differences compared to a random control condition. Neither of the two interventions had any effect on depression knowledge, attitudes toward treatment, or actual treatment seeking. The failure of these interventions to yield long-term effects is discussed in the context of successful prevention interventions for nonneurotic problem behaviors. The authors conclude that depression may be best prevented with a competency-based intervention targeting several disorders.

Coronary angioplasty after coronary bypass surgery: Initial results and late outcome in 422 patients

From 1978 to 1988, coronary angioplasty was performed in 422 patients with prior coronary artery bypass surgery (264 patients with native coronary artery angioplasty and 158 patients with graft angioplasty). Angioplasty was successful in 84%, unsuccessful but uncomplicated in 11% and complicated by one or more major cardiac events in 5% (myocardial infarction 5%, emergency bypass surgery 2% and death 0.2%). Follow-up data were obtained in 99% of 356 patients with successful angioplasty. At a mean of 33 +/- 26 months, 92% were alive, 73% had improvement in angina and 61% were free of angina. One or more of the following late events occurred in 67 patients (19%): myocardial infarction (6%), elective reoperation (13%) and cardiac death (6%). Repeat angioplasty was performed in 27%, with a success rate of 89% and no deaths. Initial success rates were equal in native vessel versus graft angioplasty, but late outcome was less favorable with the latter because of a higher rate of infarction (11% versus 4%, p less than 0.05) and need for reoperation (19% versus 10%, p less than 0.05). The initial success rate was higher in vein grafts less than 1 year old compared with grafts 1 to 4 years or greater than 4 years after operation (92% versus 85% versus 83%, respectively) and adverse late events were less frequent after angioplasty in recent vein grafts (less than 1 year 13%, 1 to 4 years 35%, greater than 4 years 29%; less than 1 versus greater than 1 year, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary rotational ablation: initial experience in 302 procedures.

OBJECTIVES The aim of this study was to assess the utility of percutaneous transluminal coronary rotational ablation in the treatment of coronary artery disease. BACKGROUND Although numerous advances have been made in the treatment of coronary artery disease, there are lesions with complex morphology that are not amenable to current intravascular therapy. METHODS A consecutive series of 242 patients having 302 coronary rotational ablation procedures was analyzed. One hundred nineteen (49%) of the patients had previously undergone attempted coronary angioplasty, which was unsuccessful in 31 patients (13%). The left ventricular ejection fraction was normal in 196 patients (81%). The ablation procedure was attempted in 308 vessels and 346 lesions. Of the 346 lesions treated, 26 (7.5%) were classified as American College of Cardiology/American Heart Association type A, and 320 (92.5%) as either type B or type C. RESULTS Procedural success was achieved in 284 (94%) of the 302 procedures and 330 (95.4%) of the 346 lesions in which ablation was attempted. Five procedures (1.7%) were unsuccessful, but no cardiac event occurred during the hospital stay. A major cardiac event occurred in 13 cases (4.3%); 9 (3%) of these complications were due to the ablation procedure. Six patients sustained a Q wave myocardial infarction alone, two had a Q wave infarction and required emergency surgery and one needed emergency surgery but did not have a Q wave infarction. No procedural deaths were attributed to the ablation procedure. Follow-up has been obtained in 182 of the 242 patients at a mean interval of 9 +/- 5 months. Of the 182 patients, 174 (95.6%) were alive and free of myocardial infarction. Angiographic follow-up is available thus far in 87 patients. By combining angiographic and clinical outcome, an overall estimated restenosis rate of 37.4% (68 of 182) was calculated. CONCLUSIONS These data suggest that coronary rotational ablation can be performed on lesions with a variety of morphologic features with high initial success rates. The overall rate of restenosis is similar to that of balloon angioplasty.

Psychologic predictors of psychosocial and medical outcomes in patients undergoing coronary angioplasty.

&NA; The relationship between psychologic variables (the match between repressive style and level of cardiac information, and anxiety level) and medical complications, re‐stenosis (renarrowing), and psychosocial adjustment was studied in 97 patients undergoing percutaneous transluminal coronary angioplasty (PTCA) for treatment of narrowed coronary arteries. Three major findings emerged for outcomes measured 6 months after PTCA: repressors with a high level of cardiac information (coping style‐information level mismatch) and no history of heart attack were at higher risk for late medical complications (p less than 0.001); sensitizers with a low level of cardiac information (coping style‐information level mismatch) and whose PTCA was only moderately successful were at higher risk for re‐stenosis of the artery previously widened during PTCA (p less than 0.01); and patients who were more anxious during hospitalization had poorer social functioning and more mood disturbance 6 months after PTCA (p less than 0.05). Thus, psychologic, information, and medical factors are important in predicting 6‐month outcomes in patients undergoing PTCA.

Bidirecctional crossover and late outcome after coronary angioplasty and bypass surgery: 8 to 11 year follow-up

Abstract Between March 1978 and July 1981, 217 symptomatic patients underwent coronary angioplasty as an alternative to coronary bypass surgery. Angioplasty was successful in 143 patients (66%), unsuccessful bet uncomplicated in 65 (30%) and complicated in 9 (4%) by one or more of the following criteria: Q wave myocardial infarction (2%), emergency surgery (4%) or death (0.5%). Late follow-up evaluation was obtained in 213 patients at a mean of 9 ± 1 years. Of patients in whom angioplasty was successful, 59 (42%) of 140 required another revascularization procedure (repeat angioplasty in 26% and bypass surgery in 16%). The actuarial survival rate at 5, 9 and 10 years after successful angioplasty was 98%, 93% and 92%, respectively. Of the 65 patients with unsuccessful and uncomplicated angioplasty (usually as a result of technical factors), 58 underwent elective bypass surgery within 2 months and 56 survived. These 56 surgical patients were compared with the 140 patients with successful angioplasty. Univariate analysis of prognostic factors did not reveal significant differences between these two groups. At late follow-up study, the successful angioplasty and the successful surgical groups had similar rates of survival (93% versus 95%, p = NS) and of death or infarction, or both (11% versus 12.5%, p = NS). p]Repeat revascularization was required more frequently after successful angioplasty than after surgery (42% versus 18%, p

GRIP STRENGTH NORMS FOR ELDERLY WOMEN

As part of community health screenings, the grip strength of 113 independently ambulatory women (M age = 75.2 ± 7.3 yr.) was measured. Norms derived from the measurements are presented and compared with (a) norms reported for similar procedures about 20 years ago and (b) values for disabled women.

Relationships Between Perceived Limitations in Stair Climbing and Lower Limb Strength, Body Mass Index, and Self-reported Stair Climbing Activity

The purpose of this study was to describe the relationships between perceived limitations in stair climbing and self-reported stair climbing activity, muscle strength, and adiposity. The study involved the cross-sectional examination of community-dwelling men (n = 32) and women (n = 107) aged at least 65 years. Perceived limitations in climbing one and several flights of stairs were identified by responses to items of the Short-Form 36. Lower limb strength was indicated by the 5 repetition sit-to-stand test. Adiposity was characterized by body mass index. Stair climbing activity was reflected by self-report of flights climbed daily. Stair climbing limitations were common among the participants. Correlational analysis showed low but significant correlations between stair climbing limitations and stair climbing activity, adiposity, and lower limb strength. Regression analysis demonstrated that the 3 independent variables combined together predicted 36.8% of the variance in limitations in climbing a single flight of stairs, and that the stair flights climbed and lower limb strength explained 22.1% of the variance in climbing several flights of stairs. While the design of the study precludes attributing cause, it appears that stair climbing limitations might be assuaged through reduction of adiposity and augmentation of lower limb strength. Stair climbing activity itself may have a direct or indirect effect on stair climbing limitations.

731-6 Longterm Followup and Crossover 15 Years After Coronary Angioplasty: Comparison of Angioplasty and Bypass Surgery Strategies

To characterize the longterm outcome in patients who had successful coronary angioplasty (PTCA) and those who had an unsuccessful, uncomplicated procedure followed by elective bypass surgery (BYPASS) between 3/78 and 6/81, late followup was obtained in 196 (140 PTCA and 56 BYPASS) patients. Mean time to followup was 12 years (range = 13–16). There was no difference between the groups in survival (PTCA – 84.8%; BYPASS – 88.9%), late myocardial infarction (PTCA – 11.3%; BYPASS – 13.0%) or freedom from angina at latest contact (PTCA – 84.1 %; BYPASS – 87.0%). In the PTCA group, 110 (78.6%) were definitively treated with one or more PTCA procedures. In the BYPASS group, 46 (82.1%) were definitively treated with one or more bypass surgeries. Twenty (14.3%) of the PTCA group crossed over to BYPASS and 8 (14.3%) of the BYPASS group crossed over to PTCA. In conclusion, PTCA and BYPASS strategies yield comparable longterm results. Crossover rates between the two therapeutic procedures are similar. It appears that repeat procedures and crossovers are important in sustaining the beneficial results for both procedures over very long periods of time.