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Influence of pre-PTCA strategy and initial PTCA result in patients with multivessel disease: the Bypass Angioplasty

K E Kip1, M G Bourassa, A K Jacobs

  • 1Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15261, USA. kip@edc.gsph.pitt.edu

Circulation
|September 1, 1999
PubMed

Insights

Incomplete revascularization (IR) strategy in multivessel coronary artery disease patients undergoing percutaneous transluminal coronary angioplasty (PTCA) is comparable to complete revascularization (CR) for long-term survival, but increases the need for coronary artery bypass grafting (CABG).

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Incomplete revascularization (IR) after percutaneous transluminal coronary angioplasty (PTCA) in multivessel coronary artery disease (CAD) arises from pre-procedural strategy and lesion outcomes.
  • The distinct impact of these factors on long-term patient prognosis remains unclear.

Purpose of the Study:

  • To evaluate the long-term impact of pre-PTCA strategy and initial lesion success on patient outcomes in multivessel CAD.
  • To compare outcomes between planned incomplete revascularization (IR) and complete revascularization (CR) strategies.

Main Methods:

  • Analysis of 2047 patients from the Bypass Angioplasty Revascularization Investigation (BARI) who underwent first-time PTCA for multivessel CAD.
  • Assessment of pre-procedural lesion importance and dilation intent by operators.
  • Definition of CR as successful dilation of all clinically relevant lesions.

Main Results:

  • Planned IR was associated with fewer intended lesions for PTCA compared to planned CR (2.1 vs. 2.8).
  • Successful dilation of all intended lesions occurred more frequently in planned IR (56%) versus planned CR (45%).
  • Multivariable analysis revealed that planned IR, initial lesions attempted, and initial lesion outcome were not associated with 5-year cardiac death or death/myocardial infarction, but were independently linked to increased risk of coronary artery bypass grafting (CABG).

Conclusions:

  • A pre-PTCA strategy of IR in BARI-like patients is comparable to CR regarding long-term survival, with the notable exception of a higher requirement for CABG.
  • Further research is needed to determine if novel devices can mitigate the increased CABG risk in patients with multivessel disease undergoing planned IR.
Abstract

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