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At least 235 records · Page 13Linked to original sources
PubMed2004

A comparison of minimally invasive open and laparoscopic radical retropubic prostatectomy.

PURPOSE: A cohort of more than 1,000 patients undergoing open minimally invasive radical retropubic prostatectomy (mini-lap RRP, 8.0 cm incision) is compared to published series of laparoscopic radical retropubic prostatectomy (RRP). MATERIALS AND METHODS: A cohort of 209 consecutive patients undergoing mini-lap RRP at Emory University Hospital was evaluated. Characteristics noted were patient age, comorbidity status, preoperative prostate specific antigen, operative time, perioperative complications, blood transfusions, pathological staging, potency and continence. Postoperative analgesia was analyzed in a cohort of 30 consecutive recent patients. These data were compared to published reports of similar perioperative characteristics in laparoscopic RRP series. RESULTS: Differences between the cohorts of patients reviewed were found in age, preoperative prostate specific antigen, operative time and rate of blood transfusion. The series were comparable in comorbidity status, postoperative complications, rates of incontinence, rates of impotence and margin positivity. Analgesic use was quantified in a small group of patients according to the amount of narcotic analgesia required during the postoperative hospital stay. CONCLUSIONS: Mini-lap RRP can generally be performed in less time and at less cost than most laparoscopic radical prostatectomies. It can be performed with regional anesthesia and has excellent postoperative results compared to contemporary laparoscopic procedures. Mini-lap RRP requires less training than laparoscopic RRP. With its minimal morbidity, mini-lap RRP remains an attractive technique that can easily be adopted by the experienced retropubic surgeon.

Adult↗
PubMed2004

Factors that influence the completion of breast reconstruction.

Post mastectomy breast reconstruction continues to evolve in both timing and technique; however, multiple surgical procedures are usually required. The purpose of this report was to determine the number of secondary procedures required to complete the breast reconstruction and factors that influence this process. All patients who underwent breast reconstruction at Emory University Hospital between 1975 and 2000 were reviewed. The end point and inclusion criterion was completion to nipple reconstruction. Secondary procedures were determined per patient for either unilateral or bilateral reconstructions, and defined as any surgical manipulation of the reconstructed breast, contralateral breast, or donor site. The cohort was stratified by timing and method of reconstruction. Additional variables included risk factors, radiation therapy, and complications. A total of 888 patients completed the reconstructive process (738 unilateral and 150 bilateral). The average number of secondary procedures was 3.99 for unilateral, and 5.54 for bilateral. Delayed reconstructions had a higher number of secondary procedures in both groups. Transverse rectus abdominus musculocutaneous flap reconstruction tended to have more secondary procedures than implant or latissimus dorsi with or without implant reconstructions. Radiation therapy increased the number of secondary procedures in unilateral (3.9 versus 4.6, P < 0.001) and in bilateral reconstructions (5.7 versus 6.4, P = 0.032). The number of secondary procedures also increased exponentially with the number of risk factors (0-4), and patients with any complication had a higher number of secondary procedures for unilateral (4.5 versus 3.6, P < 0.001) and bilateral reconstructions (6.4 versus 4.5, P < 0.001). Secondary breast and donor site procedures were used as an outcome measure to formulate comparisons. Autologous tissue reconstruction required more secondary procedures, likely in part to donor site revisions. Delayed reconstruction, the need for radiation therapy, any complication, and more risk factors significantly increased the number of secondary procedures required to complete the reconstructive process.

Adult↗
PubMed1996

Long latency ankle responses to dynamic perturbation in older fallers and non-fallers.

OBJECTIVE: The purpose of this study was to examine the effects of falling history and aging on the latency and magnitude of long latency responses in the lateral gastrocnemius (LG) and tibialis anterior (TA) muscles of older adults. DESIGN: Single observation study. SETTING: Emory University School of Medicine, Center for Rehabilitation Medicine, serving the greater Atlanta, Georgia, area. PARTICIPANTS: There were 62 community-dwelling adults aged 60 or older, 32 with a history of two or more unexplained falls in the past year and 30 with no history of falls in the past year. MEASUREMENTS: The electromyographic activity of the gastrocnemius and tibialis anterior muscles was recorded bilaterally during repeated 10 degree dorsiflexion perturbations to standing subjects at the acceleration of gravity and a velocity of approximately 100 deg/sec. The latency and magnitude of the long latency EMG responses (LLR) of both muscles were determined and compared between individuals by falls history and by decades of age. MAIN RESULTS: No significant differences between falls status groups existed for mean LLR latencies or magnitudes of either LG or TA. Attenuation of the LLR throughout the trials was significantly different between groups. Non-fallers demonstrated attenuation of the LG magnitude over the first five stretches. Fallers showed maladaptation of the LG response, with the latency becoming shorter over 25 trials. More than half of the subjects in both groups had one or more instances of temporal reversal of the response latencies, with the TA response occurring earlier than the LG response during the first five stretches. No differences existed in the LLR between age decades within faller or non-faller groups. A timed measure of mobility (Up & Go) showed a significant difference between falls status, but not between age decades in either group. CONCLUSIONS: Lack of differences between falls status and age decade groups over all trials suggests that LLRs remain intact between older fallers and non-fallers and between older age groups. The mechanism of perturbation is a distinguishing feature of this study and probably contributes to our findings. The appearance of an atypical response strategy in both groups, where the TA response often occurs before the LG response, has raised the question of whether there is always a stereotypical pattern of LLRs during postural perturbations outside the experimental setting.

Accidental Falls↗
PubMed1997

Functional outcome of cognitively impaired hip fracture patients on a geriatric rehabilitation unit.

OBJECTIVES: To compare outcomes (physical functions and discharge destinations) of cognitively impaired and intact older hip fracture patients, and to identify cognitive skills related to functional gains. DESIGN: Prospective longitudinal study of hip fracture patients treated on an acute inpatient rehabilitation service, with evaluation of functional performance and living status determined at admission and discharge. SETTING: A specialized inpatient geriatric rehabilitation program at Wesley Woods Geriatric Hospital, which is affiliated with Emory University School of Medicine. SUBJECTS: Fifty-eight hip fracture patients, 35 with and 23 without cognitive impairment. MEASUREMENTS: Cognitive functioning measured by the Mattis Dementia Rating Scale (MDRS); functional outcome assessed by the Functional Independence Measure (FIM); comparison of pre-fracture with discharge living environments. MAIN RESULTS: Both cognitively impaired and intact hip fracture patients exhibited similar overall FIM motor improvements as well as functional gains in specific FIM areas measuring self-care, sphincter control, and locomotion (e.g., walking). Cognitively intact patients, however, displayed significantly greater gains in mobility (e.g., transfers) at discharge. Cognitively impaired patients who lived in the community were as likely as intact patients to return to the community. Patients who entered the program at a modified dependence level (FIM 3-5) and achieved motor independence at discharge (FIM 6-7) had higher MDRS initiation/ perseveration and memory scores. CONCLUSIONS: Hip fracture patients with cognitive impairments can achieve positive outcomes as defined by functional improvement and discharge destination. Intensive post-fracture rehabilitation in the early phase of recovery may promote functional independence and a return to the community for older patients at risk for nursing home placement. Future research should examine the long-term maintenance of these improvements and explore how rehabilitation interventions can be altered to enhance outcome.

Aged↗
PubMed1994

Hospital resource utilization during coronary artery bypass surgery.

OBJECTIVE: To predict hospital resource utilization for coronary surgery (CABG) from preoperative characteristics and to determine the influence of previous CABG on the results. DESIGN: Two analyses of the data were used to predict hospital costs: 1) a univariate analysis of each preoperative variable; and 2) a multivariate analysis of preoperative variables, and interaction terms with previous CABG. PATIENTS: A sample of 418 patients who received CABG at Emory University during 1990. RESULTS: From the multivariate analysis, the determinants of costs were previous CABG (P = 0.0653), female sex (P = 0.1005), diabetes (P = 0.0805), older age (P = 0.0062), and a combination of previous CABG with female sex (P = 0.0017), previous myocardial infarction (P = 0.0636), low ejection fraction (P = 0.0001), and younger age (P = 0.0363). For the univariate analysis, the determinants of increased costs were similar to those from the multivariate analysis. CONCLUSION: The correlation between patients with potential medical difficulties or previous cardiovascular surgery show a positive impact on higher hospital costs.

Age Factors↗
PubMed1990

Management of ascending aortic dissections and aneurysms early and late following cardiac operations.

Intraoperative dissection and late ascending aortic dissection and aneurysm formation infrequently complicate cardiac operations but remain a significant source of morbidity and mortality. A review of 11,145 consecutive cardiac operations at Emory University from January, 1982 through December, 1988 yielded 27 patients with an intraoperative ascending aortic dissection (incidence 0.24%) occurring at the time of the original procedure, with a hospital mortality of 14.8%. Nine additional patients with ascending aortic dissection or aneurysm, presenting late after a previous cardiac operation, were treated during this same period with three deaths. The technical aspects and decision making for application of closed aortic plication, open aortic reconstruction, and ascending aortic replacement based directly on the extent of the intraoperative dissection is detailed. An individualized technical approach tailored to the pathology encountered is outlined for the reoperative group of patients. Etiology, risk factors, principles of prevention, and indications for operation are also discussed.

Aged↗
PubMed1994

Mitral valve replacement: indications, choice of valve prosthesis, results, and long-term morbidity of porcine and mechanical valves.

Indications for specific valve types, whether they be mechanical or bioprosthetic, have been rigorously defined in recent years. Candidates for bioprosthetic valves would be: older patients, patients who are noncompliant or have contraindications to anticoagulation, patients in normal sinus rhythm, and young females desirous of future pregnancy. Recent data suggest that patient age and presence of coronary artery disease may significantly alter the indications for mechanical or tissue valves. There is mounting evidence that patients without coronary disease in their 60s and 70s who require valve replacement are better served with a mechanical prosthesis. At Emory University Hospitals, 440 patients operated upon between 1974 and 1981 were followed for a mean period of 8.3 years. No patients having coronary artery disease were included in the cohort. Survival at 10 years was 64%. The actuarial freedom from all major valve related complications at the end of 10 years is compared to other series. Data suggests that patient survival for mitral valve replacement is affected by the etiology of the valve disease necessitating the operation. The best survival occurs in patients in whom the mitral valve replacement is for myxoid degeneration and may explain the excellent survival to be expected for mitral valve repair and concomitant coronary bypass. The most significant factor increasing morbidity and mortality in patients with mitral valve replacement and coronary artery disease is high end-diastolic pressure associated with significant depression of regional wall motion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2001

Autoimmune hepatitis in African Americans: presenting features and response to therapy.

OBJECTIVES: African Americans are at an increased risk for certain diseases and more frequently suffer complications of those diseases relative to their white counterparts. Most studies of autoimmune hepatitis consist of entirely white populations. The Emory University system of hospitals serves a large African American population, including a significant number of African Americans with autoimmune hepatitis. The goal of this study was to determine if the presentation and response to therapy in African Americans is, like other diseases, different than in whites. METHODS: This is a retrospective study from a tertiary referral center that examines the initial presenting features and response to therapy of African Americans (n = 27) and whites (n = 24) with autoimmune hepatitis. RESULTS: Eighty-five percent of African Americans had cirrhosis on the initial liver biopsy, as compared with 38% of whites. Although not statistically significant, the African Americans presented at an earlier age than white patients. The disease also appeared more advanced in African Americans, as bilibubin levels tended to be higher, but not significantly, and PTs were more prolonged. Both groups responded well to therapy, with significant falls in serum levels of AST, ALT, and bilirubin. Fifty percent of African Americans and 48% of whites entered a biochemical remission. The amount of prednisone required to maintain remission at follow-up was greater in African Americans. CONCLUSION: In contrast to whites, the majority of African Americans present with cirrhosis. Despite the high prevalence of cirrhosis, the response to therapy is good. However, more immunosuppression is required to control the disease in African Americans.

Adult↗
PubMed1962

Enzymatic activities associated with clotting of fibrinogen by staphylocoagulase and coagulase-reacting factor and their inhibition by disopropylfluophosphate.

Drummond, Margaret C. (Emory University, Atlanta, Ga.) and Morris Tager. Enzymatic activities associated with clotting of fibrinogen by staphylocoagulase and coagulase-reacting factor and their inhibition by diisopropylfluorophosphate. J. Bacteriol. 83:975-980. 1962.-The chemical mechanism of fibrinogen clotting by staphylocoagulase and its plasma factor (CRF) involves a preliminary stage of proteolysis, analogous to that found in thrombin-catalyzed fibrinogen clotting. Coagulase-CRF also exhibits N-alpha-toluene-p-sulfonyl-l-arginine methyl esterase activity in addition to its fibrinogen-clotting and proteolytic activities. These enzymatic activities have been further studied by their responses to certain enzyme inhibitors, and from the standpoint of their possible interrelationships.

Arginine↗
PubMed1963

FIBRINOGEN CLOTTING AND FIBRINO-PEPTIDE FORMATION BY STAPHYLOCOAGULASE AND THE COAGULASE-REACTING FACTOR.

Drummond, Margaret C. (Emory University, Atlanta, Ga.) and Morris Tager. Fibrinogen clotting and fibrino-peptide formation by staphylocoagulase and the coagulase-reacting factor. J. Bacteriol. 85:628-635. 1963.-The mechanism of fibrinogen clotting by staphylocoagulase and the coagulase-reacting factor (CRF) was studied from the standpoint of the products of the reaction, and compared with thrombin clotting of fibrinogen. Both clotting principles effect clotting with the release of nonprotein nitrogenous material, which can be resolved into three peptides by Dowex-50 chromatography. On the basis of the sedimentation constants, electrophoretic mobilities, and end-group analyses of these peptides, it appears that the products of fibrinogen clotting by coagulase-CRF and by thrombin are similar.

Coagulase↗
PubMed1964

PATHWAYS FOR BIOSYNTHESIS OF A BACTERIAL CAPSULAR POLYSACCHARIDE. IV. CAPSULE RESYNTHESIS BY DECAPSULATED RESTING-CELL SUSPENSIONS.

Juni, Elliot (Emory University, Atlanta, Ga.), and Gloria A. Heym. Pathways for biosynthesis of a bacterial capsular polysaccharide. IV. Capsule resynthesis by decapsulated resting-cell suspensions. J. Bacteriol. 87:461-467. 1964.-Methods were devised for stripping capsules from encapsulated bacteria. By use of stripped resting-cell suspensions of a gram-negative capsule-forming coccus, it was shown that polysaccharide capsule resynthesis depends upon the presence of air and an oxidizable substrate. Capsule resynthesis proceeds linearly with time. For a given quantity of stripped cells, the net amount of polysaccharide capsule synthesized is a linear function of the amount of substrate oxidized. The only factor that appears to limit the extent of capsule synthesis by resting cells is the amount of substrate utilized. A series of photomicrographs of wet mounts made in India ink show the appearance of stripped cells and resynthesized capsules formed during oxidation of pyruvate and glucose by stripped resting-cell suspensions.

Acetates↗
PubMed1997

High incidence of scintigraphic myocardial uptake defects at rest and during exercise in male elite runners.

OBJECTIVE: To evaluate the usefulness of myocardial perfusion scintigraphy (MIBI-SPECT) as a diagnostic tool in well trained men. DESIGN: The study was prospective, involving 2 d stress-rest myocardial scintigraphy (MIBI-SPECT), polar map reconstruction with and without uniform attenuation correction, and comparison with a healthy male group (local Swedish) and with a commonly used reference group (American, Emory University Hospital). SETTING: University Hospital, Stockholm, Sweden. SUBJECTS: 16 healthy, male elite runners (mean (SD) age 26.1 (3.1) years). Peak oxygen uptake 73 (4) ml O2/kg/min. RESULTS: Uptake defects on polar maps were found in the majority of the runners compared with both reference groups (local Swedish 13/16, American 10/16). Most defects (91%) were fixed. Defects were located in the anterior, lateral, and posterior regions of the left ventricle. Application of a uniform attenuation correction algorithm enhanced rather than reduced perfusion defect size, probably because this correction method is imperfect in SPECT studies of the thoracic cavity. CONCLUSIONS: If myocardial perfusion scintigraphy is used for evaluating well trained men, existing normal reference files for semiquantitative evaluation appear to be inadequate.

Adult↗
PubMed2000

Targeting patients undergoing angioplasty for thrombus inhibition: a cost-effectiveness and decision support model.

BACKGROUND: In recent clinical trials, glycoprotein IIb/IIIa blockers have demonstrated effectiveness in preventing adverse events after angioplasty in high-risk patients. However, uncertainty exists regarding the cost-effective selection of patients to receive antiplatelet therapy. METHODS AND RESULTS: All 4962 patients at Emory University Hospitals who underwent coronary intervention procedures (n=6062) from 1993 to 1995 were studied. Multivariate models to predict death and the composite of death, Q-wave and non-Q-wave myocardial infarction, and emergency additional revascularization were developed. Hospital costs and professional costs were determined. A cost-effectiveness analysis with therapy targeted to high-risk patients was performed. If patients with a >5% probability of events received antiplatelet therapy that reduced events by 24% and cost $1000, 40.1% of patients would receive therapy; complications would be reduced from 6.39% to 5.37%, and cost would increase $261 from $10343 to $10604, or $25504 per event prevented. The marginal cost per event prevented by moving from a 7% to a 5% probability of an event cutoff would be $57 799. CONCLUSIONS: For high-risk patients, there may be cost savings; for low-risk patients, therapy may not be cost effective; and for patients in the midrange (between 5% and 7% probability of an adverse event), events may be prevented at an acceptable level of cost.

Angioplasty↗
PubMed1983

Acute occlusion after percutaneous transluminal coronary angioplasty--a new approach.

Between July 1980 and November 1982, there were 935 coronary angioplasties attempted at Emory University Hospital. Of these patients, 20 developed acute occlusion. Of these 20, 19 presented within 3 hr of surgery or within 3 hr after stopping a continuous heparin infusion. Five patients required emergency surgery, but in 15 nitrates, nifedipine, and/or repeat angioplasty reopened the artery and the patient could be stabilized on continuous infusions of heparin and nitroglycerin. In only one case was an occluding thrombus evident on angiographic examination. The mechanism of acute occlusion is unknown, but coronary artery spasm may play a role.

Acute Disease↗
PubMed1985

In-hospital morbidity and mortality in patients undergoing elective coronary angioplasty.

We prospectively recorded all in-hospital complications of the first 3500 consecutive patients to undergo elective coronary angioplasty (PTCA) at Emory University Hospitals from July 14, 1980, to August 28, 1984, by three operators. PTCA was attempted in a total of 3933 lesions, with a primary success rate of 91%. Multiple-lesion PTCA was performed in 401 patients, and PTCA of saphenous vein grafts was attempted in 172. No complications were recorded in 3116 (89%) cases, isolated minor complications occurred in 241 (6.9%), and major complications (emergency surgery, myocardial infarction, death) were observed in 145 (4.1%). Emergency coronary artery bypass graft surgery (CABG) was performed in 96 patients (2.7%), with a myocardial infarction rate of 49% (47/96), a Q wave infarction rate of 23% (22/96), and an emergency surgery mortality rate of 2% (2/96). Hospital discharge occurred within 2 weeks of attempted PTCA in 91% (87/96) of patients undergoing emergency CABG. The overall myocardial infarction rate was 2.6% (94/3500). There were two nonsurgical deaths, giving a total mortality rate of 0.1% (4/3500). Univariate and multivariate analysis of 3099 patients undergoing single-lesion PTCA identified five preprocedure predictors of a major complication: multivessel coronary disease, lesion eccentricity, presence of calcium in the lesion, female gender, and lesion length. Unstable angina, duration of angina, lesion severity, previous CABG, and vein graft dilatation were not associated with an increased incidence of major complications. The strongest predictor of a major complication was the procedural appearance of an intimal dissection. Intimal dissection was evident in 894/3099 (29%) patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon↗
PubMed1989

Determinants of prolonged length of hospital stay after coronary bypass surgery.

The length of hospital stay after coronary surgery was studied in 4,683 patients undergoing cardiac catheterization followed by coronary surgery at Emory University Hospital or Crawford Long Hospital between the years 1981 and 1986. Length of stay after coronary surgery had a median and modal value of 7 days. There was, however, a long statistical tail of patients with a prolonged length of stay extending out to more than 180 days. Prolonged length of stay (greater than 10 days) could be correlated with preprocedural variables such as age, elective versus emergency status, angina class, ejection fraction, and gender. Length of stay increased from a mean of 6.9 +/- 1.4 days under the age of 40 years to 10.9 +/- 12.1 days over the age of 70 years (p less than 0.0001). Length of stay was correlated with the periprocedural variables of wound infection, neurologic event, arrhythmias, pneumonia, postoperative myocardial infarction, mortality, and pericarditis. Length of stay increased from 8.8 +/- 9.6 days without a neurologic event to 21.1 +/- 17.9 days with a neurologic event (p less than 0.0001). Similarly, without a wound infection, the average stay was 8.7 +/- 8.9 days; with a wound infection, the average stay was 32.2 +/- 25.8 days (p less than 0.0001). The correlates of prolonged stay were tested in another population comprising 781 patients undergoing cardiac catheterization followed by coronary artery bypass grafting in 1987. The predictors of prolonged stay in the 1987 population were wound infection, pneumonia, arrhythmias, age, neurologic events, postoperative infarction, and ejection fraction. Thus, length of hospital stay after coronary surgery may be predicted by multiple preprocedural and periprocedural variables.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Percutaneous transluminal coronary angioplasty of chronic total occlusions. Primary success, restenosis, and long-term clinical follow-up.

BACKGROUND: Angioplasty of chronically totally occluded vessels has been associated with a success rate well below and restenosis rate well above that for angioplasty of stenosed segments. However, long-term clinical outcome after successful revascularization of a chronically totally occluded vessel has not been reported in detail. METHODS AND RESULTS: Accordingly, data for 480 patients undergoing angioplasty for chronic total occlusion at Emory University Hospital, Atlanta, Ga., from 1980 to 1988 were analyzed for predictors of in-hospital procedural and clinical (procedural success and absence of in-hospital complications) success, restenosis, and 4-year clinical follow-up. The study population was grouped by procedural and clinical success and failure. The groups were then compared for outcome, both in hospital and long term. The initial clinical success rate was 66% (317 of 480 patients). Independent correlates of failure were the number of vessels diseased (p less than 0.001), vessel location of the lesion (p = 0.016), and absence of any distal antegrade filling (p = 0.002). Follow-up data revealed 98% cardiac survival and 96% overall survival at 4 years for the group as a whole. Freedom from myocardial infarction or cardiac death was significantly greater in patients with clinical success (93%) than with clinical failure (89%, p = 0.0044). In the successful group, 87% were free from coronary surgery after 4 years compared with 64% in the failure group (p less than 0.0001). Two thirds of the patients were free of angina at last follow-up. The presence of angina at follow-up was the same for patients successfully treated and for those with failed angioplasty, which may be related to the frequent use of coronary surgery in the failure group. CONCLUSIONS: In well-selected cases, the success rate for angioplasty of chronic total occlusion is acceptable. Furthermore, long-term clinical benefit is suggested by the high freedom from coronary surgery, myocardial infarction, and death in the patients who underwent successful revascularization.

Angioplasty, Balloon, Coronary↗
PubMed1993

Long-term clinical follow-up in patients with angiographic restudy after successful angioplasty.

BACKGROUND: Restenosis remains a critical limitation after coronary angioplasty. There is little information comparing long-term prognosis in patients who suffer from restenosis and others who do not. The purpose of this paper is to determine the clinical events in patients with restenosis or continued patency documented by restudy coronary arteriography. METHODS AND RESULTS: The source of data was the clinical data base at Emory University. Patients who had previous coronary surgery and patients who underwent angioplasty in the setting of acute myocardial infarction were excluded. A total of 3,363 patients undergoing angiographic restudy 4 months to 1 year after angioplasty were compared with 3,858 not undergoing restudy. In the restudy population, 1,570 had restenosis and 1,793 had patent arteries at all sites dilated. The restenosis patients were older and had more hypertension, more diabetes, more severe angina, more multivessel coronary artery disease, more severe stenoses, and less satisfactory original results. At restudy, in patients without restenosis, 38.7% had angina versus 70.7% in patients with restenosis (p < 0.0001). There were few deaths in the first 6 months. At 6 years, the survival rate was 0.95 without restenosis and 0.93 with restenosis (p = 0.16). At 6 months and 6 years, freedom from myocardial infarction was 0.97 and 0.88 without restenosis and 0.93 and 0.85 with restenosis (p = 0.0001). On multivariate analysis, restenosis was an independent correlate of myocardial infarction but not mortality. At 6 months and 6 years, freedom from coronary bypass surgery was 0.99 and 0.94 without restenosis and 0.91 and 0.78 with restenosis (p < 0.0001). At 6 months and 6 years, freedom from repeat angioplasty was 0.96 and 0.76 without restenosis and 0.44 and 0.20 with restenosis (p = 0.0001). The highest event rates were noted in the patients with restenosis with recurrent chest pain. Patients not undergoing restudy differed somewhat from the study group, and there were far fewer repeat revascularization procedures in the group not undergoing restudy. CONCLUSIONS: Patients with restenosis are more likely to have recurrent angina pectoris. Although there is no or little difference in survival, there is a difference in myocardial infarction rate in the patients with and without restenosis. The low myocardial infarction and death rates in the group suffering restenosis may be related to repeat revascularization in these patients; the principal events in the restenosis population are frequent repeat revascularization procedures.

Aged↗