Coronary angioplasty is an effective treatment for patients with angina at rest, either refractory or initially stabilized but returning despite pharmacologic treatment, and with early postinfarction angina. The procedure has a high initial success rate, but there is an increased risk of major complications resulting from a higher incidence of acute closure, which may be related to preexisting thrombus. Resolution of this problem may be achieved by the use of more potent antiplatelet treatment, pretreatment with thrombolytic agents, or treatment that can be applied locally (e.g., laser energy, atherectomy) at the site of the unstable plaque. Results in this study have been obtained from selected groups of patients: those with predominantly single-vessel disease and well-preserved left ventricular function. It remains to be determined whether the same benefits can be achieved in patients with multivessel disease or in those who have severely reduced left ventricular function.
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