IMMEDIATE AND LONG-TERM RESULTS OF PERCUTANEOUS - TRANSLUMINAL CORONARY ANGIOPLASTY IN PATIENTS UNDER 35 YEARS OF AGE

Over an eleven year period, 57 patients under 35 years of age underwent percutaneous transluminal coronary angioplasty (PTCA). The features of the study population were : 55 men and 2 women, average age 32 +/- 3 years; unstable angina in 30 %, previous myocardial infarction in 53 %, average left ventricular ejection fraction 59 +/- 12 %, single vessel disease in 84 %. A total of 63 vessels were dilated. The primary success rate was 81 % (72 % in the first 29 patients compared with 89 % in the latter 28 patients, p = 0.1). The following complications were observed : peri-procedural infarction (4 cases), emergency coronary bypass surgery (4 cases), no fatalities. During follow-up (average 6 +/- 3 years), of the 43 patients who underwent control coronary angiography in the last 6 months, 14 (33 %) had angiographic restenosis. The long-term outcome was marked by 5 coronary bypass operations (3 for restenosis, 1 after failure of PTCA and 1 for progression of the coronary disease), 8 PTCAs for a new lesion due to progression of the coronary disease, 2 deaths and 2 non-lethal infarctions. The 10 year survival was 96 +/- 3 % and the survival rate without cardiac events (infarction, surgical revascularisation or repeat PTCA) was 62 +/- 10 % at 10 years. Of the 54 survivors, 50 (92 %) have no angina, and 44 (81 %) continue to take antiischaemic drug therapy. Of the 50 patients who were in full employment, 37 (74 %) have gone back to full-time working and 8 (16 %) have taken part-time jobs. In patients under 35 years of age, PTCA is associated with a high probability of success and a low complication rate. The long-term results seem to be excellent. However, the possibility of a new revascularisation procedure for restenosis is common in the first months and the need for repeat PTCA for progression of the coronary disease is not uncommon after a few years.