Author + information
- Received October 23, 1989
- Revision received February 7, 1990
- Accepted March 13, 1990
- Published online August 1, 1990.
- Fayaz A. Shawl, MD, FACCa,
- Carlos E. Velasco, MD∗,
- Thomas S. Goldbaum, MD, FACCa and
- Mervyn B. Forman, MD, PhD, FACC∗∗,1
- ↵∗Address for reprints: Mervyn B. Forman, MD, PhD, Division of Cardiology, CC-2218 Medical Center North, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2170.
The effect of semiemergent percutaneous transluminal coronary angioplasty on clinical and electrocardiographic (ECG) variables was assessed in 76 patients with unstable angina secondary to an isolated severe proximal left anterior descending coronary artery stenosis. All patients manifested symmetric T wave inversion in two or more anterior ECG leads. Wall motion abnormalities were present in 37 patients on ventriculography before dilation.
Angioplasty was successful in 70 patients (92%), resulting in a reduction in luminal diameter stenosis from 91 ± 8% to 21 ± 6%, with no major acute procedure-related complications observed. The other six patients underwent semiurgent (< 48 h) coronary artery bypass surgery and three patients experienced a myocardial infarction (before bypass surgery in two). Serial ECGs revealed complete resolution of ST-T wave changes in 51% of patients at 14 weeks and in 90% at 28 weeks. In contrast, prolongation of the corrected QT interval, which was present in 16 patients (8%), normalized within 48 h of successful angioplasty. Twelve of these 16 patients with a prolonged QT interval had nonocclusive thrombus formation and poor collateral circulation on angiography.
Patients were followed up for 6 to 43 months (mean 23 ± 10). Angiographic evidence of restenosis was present in 34% of patients, all of whom underwent a successful second or third procedure. One death occurred at 8 months alter successful aagiophsty. Wall motion abnormalities had completely resolved in 13 of 15 patients who underwent repeat ventriculography, at which time 10 had a normal ECG.
This study demonstrates that ECG changes may persist for up to 7 months in patients who undergo successful angioplasty for severe left anterior descending coronary artery disease and unstable angina. Semiemergent angioplasty was associated with a high initial success rate and excellent long-term outcome.
↵1 Dr. Forman is a recipient of a First Award from the National Institutes of Health. Bethesda, Maryland.
☆ Part of this work was presented in abstract form at the Meeting of the American Federation of Clinical Research, San Diego, California, May 1987.
- Received October 23, 1989.
- Revision received February 7, 1990.
- Accepted March 13, 1990.