Is there a prognostic indication forPTCA?

Coronary angioplasty is classically indicated to remove a high grade stenosis of a major coronary vessel supplying a large myocardial territory in a symptomatic patient with proven myocardial ischemia. The coronary anatomy has to be suitable for PTCA to ensure a high successrate for the procedure. PTCA is performed to remove symptoms and myocardial ischemia to improve the prognosis of the patient. In contrast to this, the term "prognostic indication" describes an interventional approach to an angiographically documented high grade stenosis in an asymptomatic patient without proven myocardial ischemia thereby hoping to improve the prognosis of this patient. It has to be expected, that up to 20 % of all patients treated by balloon angioplasty and 10 % of all stented patients are treated with respect to a "prognostic indication". Until now, there are no statistically significant large-scale studies supporting a benefit of an interventional therapy performed with a "prognostic indication" in asymptomatic patients without ischemia. Nevertheless, some certain subgroups of patients may be candidates for a "prognostic indication" to angioplasty compared to the results of medical therapy. In patients treated interventionally for a "prognostic indication" the acute and long-term individual risk of the underlying coronary disease must be carefully weighted against the risk of the interventional procedure.