A Man With a 40-Year Event-Free Follow-Up After Percutaneous Coronary Intervention
Author + information
- Augusto Gallino, MD∗ (augusto.gallino{at}me.com),
- Tiziano Moccetti, MD,
- Heinz Hirzel, MD and
- Bernhard Meier, MD
- ↵∗Cardiocentro Ticino Lugano, Via Tesserete 48, 6900 Lugano, Switzerland
As reported during the passing 40-year percutaneous transluminal coronary angioplasty anniversary and recently published in JACC: Cardiovascular Interventions, almost all has been said about transluminal angioplasty (1). We report here the case of a 42-year-old man with typical angina pectoris Canadian Cardiovascular Society Class II and a pathological electrocardiogram stress test who underwent diagnostic coronary angiography performed by one of us (T.M.) in March 1978. It showed a 90% focal stenosis of the proximal left anterior descending coronary artery. The patient was referred to the University Hospital of Zurich where a heart team, comprising the cardiac surgeon Åke Senning and the inventor of percutaneous coronary intervention (PCI) Andreas Gruentzig, decided to propose balloon angioplasty to the patient. He consented orally, and PCI was performed in June 1978 as number 5 of Gruentzig’s initial series with an excellent angiography result (2). The patient was discharged 2 days later with atenolol 50 mg/day and oral anticoagulation, and soon returned to work and to playing tennis as a private instructor. During the last 40 years, he was followed up regularly by 2 of us (H.H., A.G.). Chest pain or other cardiac symptoms did not return. Coronary angiography at 1, 2, 5, and 10 years showed absence of restenosis, and serial myocardial scintigraphy (Sestamibi) including the last one performed in December 2017 were negative for ischemia.
Beyond the unusually long, event-free follow-up of one of the world’s first patients undergoing PCI, this case reveals several interesting aspects.
PCI would not have seen the light of the day at that time in Zurich if not for a close research, clinical, and personal cooperation between cardiac surgeons and cardiologists. In a way, Gruentzig and Senning and their respective crews anticipated the modern concept of the heart team (3).
The Achilles’ heel of balloon angioplasty was the high rate of restenosis, reaching 35% in coronary arteries and 60% in the lower limb arteries with longer lesions (4). For almost 3 decades, the cardiology community, including basic and clinical research, were striving to understand and tackle restenosis. The introduction of bare-metal stents (5) obviated negative vessel remodeling (an important restenosis mechanism), but not intima-media hyperplasia. Drug-eluting stents finally achieved a marked reduction of restenosis (6) and also were less prone to the feared event of stent thrombosis. It remains elusive and unexplained why a significant proportion of patients undergoing simple balloon angioplasty (30%) never develop restenosis as in the case of our patient.
Gruentzig’s procedures gave rise to an explosion of devices in a new and ever-growing economic market.
Footnotes
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2018 American College of Cardiology Foundation
