Safety and success of the beginning percutaneous transluminal coronary angioplasty program using the steerable guidewire system

To determine the safety and success rate of a beginning percutaneous transluminal coronary angioplasty (PTCA) program using the steerable guidewire system, results of the initial 100 attempted dilatations were analyzed. In accordance with recommended guidelines, the operators had extensive experience in cardiac catheterization and attended demonstration courses in PTCA to learn the technique, but had no in-laboratory training or assistance from experienced PTCA operators. Using the same criteria for success and complications, the results with the steerable guidewire system were compared with those of the National Heart, Lung, and Blood Institute Registry of programs beginning coronary angioplasty with the nonsteerable, fixed guidewire system. Success rates were 95% and 59%, emergency coronary artery bypass surgery 1% and 6%, acute coronary occlusion 1% and 5%, and myocardial infarction 3% and 5%. The success and complication rates were similar for each decile in the 100 procedures, in contrast to the Registry in which results significantly improved as operator experience increased. The average stenosis was reduced from 86 to 28% and the average gradient was reduced from 51 mm Hg to 14 mm Hg. These results indicate that cardiologists experienced in cardiac catheterization can start a PTCA program using the steerable guidewire system and have an improved learning curve compared with previously reported experience in which the nonsteerable, fixed guidewire system was used. With careful case selection, results comparable to those of experienced PTCA operators can be achieved. These findings may provide a more accurate prediction of the results that can be expected in a beginning PTCA program using current techniques and equipment.