Percutaneous Transluminal Coronary Angioplasty in the Young Patients - Siriraj Hospital's Experience
LILY SINGHAVIRANON,M.D.*, CHUNHAKASEM CHOTINAIWA TTARAKUL, M.D.*, BURIN KWO-SA-ARD, B.Ed.*, AMONWAN KANABENCHA, B.Sc. (Nursing)*, SUPACHAI CHAITHIRAPHAN, M.D.* NITHI MAHANONDA, M.D.*, ANNA CHIRAPASTAN, B.Sc. (Nursing)*, PRAJAK TANAPIBUNPON, B.Sc.*, TAVORN JAIDEE, Cert.PN.*,
Affiliation : * Her Majesty's Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
The aim of this study was to follow-up immediate and long term results of patients aged
less than 40 years with CAD treated by PTCA. Primary end points were to record major coronary
events, incidence and timing of restenosis and requirement of repeated revascularization after
initial PTCA.
Data was collected retrospectively from records of patients aged less than 40 years
who underwent PTCA from Jan 1996 to June 1998 in Her Majesty Cardiac Center, Siriraj
Hospital. Patients were followed up and data was collected regarding recurrent angina. major
coronary events and results of repeated coronary angiography and revascularization if available.
Out of 830 procedures performed for 325 patients, 30 patients (9'K) were less than 40
years of age and comprised of 26males (87%) and 4 females ( 13% ). Eighteen patients (60o/r) had
more than one risk factor. The most important risk factor was smoking (60o/c) followed by dys-
lipidaemia (47%) and family history of coronary artery disease (20o/c). DM was strikingly uncom-
mon. 14 patients had single vessel disease and 16 patients had multiple vessel disease. Initial stenosis
was 87.5 ± 9.8 and residual stenosis was 17.8± I 0.8. PTCA failed for 5 lesions, overall success rate
was 89 per cent. Stent was used for 12 lesions in 10 patients. There was no major complication
during the procedure. Minor complications included non occlusive dissection in four cases and
groin haematoma in three cases. The follow up ranged from 7-36 months with the median of 23
months. During follow up, there was no major cardiac event such as death, acute MI, congestive
heart failure or cerebero-vascular accident. Eleven patients (37o/c) had sustained improvement
without recurrent angina. Recurrent angina occurred in 19 patients (63%) after initial PTCA and
second/third recurrent angina occurred in 5 patients. On repeated coronary angiography angio-
graphic restenosis was seen in 10 patients (33%) after initial PTCA. Overall repeated revascu-
larization was done twenty times for sixteen patients which included 4 CABGs and 16 PTCA.
Twenty one patients (70%) showed sustained improvement after repeated PTCA and medications.
Follow up results of PTCA in young patients showed sustained improvement but achieved at
high rate of repeated revascularization.
Keywords : PTCA, Young Patients
