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.

A 10-year naturalistic study of 313 patients who entered treatment for unipolar depression and a community comparison group of 284 nondepressed adults was conducted. We compared life stressors, social resources, personal resources, and coping among patients who were remitted (N = 76), partially remitted (N = 146), or nonremitted (N = 91). Compared with the controls and the remitted patients, the partially remitted and nonremitted patients consistently experienced more life stressors and fewer social resources, were less easygoing, and relied more on avoidance coping. A less easygoing disposition, fewer close relationships, and more reliance on avoidance coping were associated with higher odds of experiencing a course of partial remission or nonremission. In addition, more depressive symptoms and medical conditions predicted nonremission.

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.

The length of hospital stay after coronary surgery was studied in 4,683 patients undergoing cardiac catheterization followed by coronary Unusually prolonged stay appears to depend on the occurrence of relatively uncommon but severe complications. (Circulation 1989;80:276-284) In recent years there has been considerable interest in controlling hospital costs. This is especially germane with regard to coronary bypass surgery"2 because this operation is the most commonly performed major operation in the United States and accounts for a considerable expenditure of total health care resources.3 Thus, it is of importance to determine which factors influence these costs. A clear determinant of resource use will be length of hospital stay.4 The purpose of our study was to evaluate those factors that result in prolonged hospital stay after coronary surgery. To this end, multiple clinical, angiographic, and intraoperative factors as well as multiple complications were used to predict length of stay.

A total of 189 consecutive new women patients were surveyed at an adult psychiatric outpatient clinic which did not have a specific program for the treatment of alcoholics. Twenty-seven patients (14%) reported a history of heavy alcohol consumption measured by scores of 10 or more on the Michigan Alcoholism Screening Test (MAST), but only 16 had a diagnosis of alcohol abuse or alcohol dependence made by a clinician. Those with a self-reported history of physical and/or sexual abuse had significantly higher scores on the MAST than those with no such history. When the first abuse occurred before the age of 18 years and there was no recent reported abuse, the association of abuse and high MAST scores persisted, suggesting that early physical or sexual abuse may be associated with current levels of alcohol use.