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Coronary arteriography and percutaneous transluminal coronary angioplasty. Changing patterns of use and results.

The use and practice patterns associated with coronary arteriography and percutaneous transluminal coronary angioplasty (PTCA) have significantly changed since their initial application for the diagnosis and treatment of coronary atherosclerotic heart disease. From 1981 to 1986 at Emory University Hospital, there has been increased use of PTCA as the initial revascularization technique employed in patients undergoing their first known coronary arteriogram. This practice pattern has resulted in a dramatic increase in patient age and disease complexity in those currently referred for coronary artery bypass graft surgery. Since 1980, PTCA success rates have improved and complications decreased due to operator experience and technical innovation. Long-term follow-up studies of patients initially treated with PTCA have documented excellent survival in those with single-vessel disease and milder forms of multiple-vessel disease. The application of PTCA as an initial revascularization strategy in patients with more diffuse and complex multiple-vessel disease is not known and awaits the results of ongoing prospective randomized trials.