Ten-year completed follow-up of percutaneous transluminal coronary angioplasty: the early Zurich experience

Department of Medicine, Emory University Hospital, Atlanta, GA 30322.

OBJECTIVES. The objective of this communication was to report the long-term follow-up of all the patients treated by Dr. Andreas Gruentzig in Zurich, Switzerland. BACKGROUND. The first patients to undergo percutaneous transluminal coronary angioplasty had the procedure performed by Andreas Gruentzig in Zurich between 1977 and 1980. The method of angioplasty has changed little, and the patients undergoing these first procedures were similar to many patients undergoing angioplasty today; therefore, their long-term outcome is of significant interest. METHODS. All 169 patients with attempted angioplasty during Gruentzig's years in Zurich have now been completely followed up at 10 years. All surviving patients were contacted directly or by telephone interview, and the occurrence of each cardiac procedure and coronary event was analyzed. RESULTS. One hundred thirty-three of the 169 patients underwent successful angioplasty. Ten-year follow-up of this group revealed an overall survival rate of 89.5%. The survival rate was 95% among patients with single-vessel disease and 81% among those with multivessel disease. Patients undergoing unsuccessful dilation and those with failed angioplasty and subsequent bypass surgery had a similar 10-year survival rate. Angiographic restenosis was present in 31% at 6 months. Late restenosis between 6 months and 10 years occurred in eight patients; however, progression of disease in undilated segments occurred in 31 patients. In addition to a better survival rate, patients with single-vessel disease were less likely to have had bypass surgery and were more likely to be angina free at the 10-year follow-up than were patients with multivessel disease (79% vs. 67%). CONCLUSIONS. This earliest angioplasty experience was also the first to demonstrate a difference in outcome between patients with single-vessel and multivessel disease treated with angioplasty. Although angioplasty is now performed in more complex patient subsets, the long-term outcome of these "classic" angioplasty patients should be applicable to similar patients treated today.

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