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Multivessel and single-vessel coronary angioplasty: a comparative study
J Hollman1, C Simpfendorfer, I Franco
1Department of Cardiology, Cleveland Clinic Foundation, OH 44195-5066.
Insights
Multivessel coronary angioplasty shows comparable outcomes to single-vessel angioplasty in major complications and 5-year survival. However, multivessel procedures have a higher rate of repeat coronary angioplasty within the first year.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Coronary artery disease often involves multiple vessels, necessitating treatment strategies that address this complexity.
- Multivessel coronary angioplasty aims to revascularize all significantly diseased coronary arteries in a single procedure.
- The comparative efficacy and safety of multivessel versus single-vessel angioplasty require thorough investigation.
Purpose of the Study:
- To compare the efficacy and safety of multivessel coronary angioplasty with single-vessel angioplasty.
- To evaluate in-hospital complications, long-term survival, and event-free survival between the two treatment groups.
- To identify specific outcomes that may differ between multivessel and single-vessel angioplasty.
Main Methods:
- A retrospective comparison of 569 consecutive patients undergoing multivessel angioplasty against 569 age- and sex-matched controls undergoing single-vessel angioplasty.
- Analysis of baseline characteristics, including left ventricular function and number of diseased vessels.
- Assessment of major in-hospital complications (death, myocardial infarction, bypass surgery) and 5-year actuarial survival rates.
Main Results:
- In-hospital complication rates for death, Q wave myocardial infarction, and emergency bypass surgery were similar between multivessel and single-vessel angioplasty groups.
- Five-year actuarial survival rates were comparable: 93% for multivessel angioplasty and 92% for single-vessel angioplasty.
- Event-free survival was similar, with the exception of an 8% higher incidence of repeat coronary angioplasty in the first year for patients who underwent multivessel angioplasty (p = 0.03).
Conclusions:
- Multivessel coronary angioplasty is a safe and effective treatment option with outcomes comparable to single-vessel angioplasty regarding major complications and long-term survival.
- The primary difference observed is a higher need for repeat coronary angioplasty in the first year following multivessel procedures.
- These findings support multivessel angioplasty as a viable strategy for patients with multi-vessel coronary artery disease, while acknowledging the increased likelihood of repeat interventions.
Abstract:
To determine the efficacy of multivessel coronary angioplasty, 569 consecutive patients undergoing multivessel angioplasty were compared with 569 age- and sex-matched control patients undergoing single-vessel angioplasty. Baseline variables were similar except for number of diseased vessels and greater left ventricular dysfunction in the multivessel group. Major in-hospital complication rates (death, 0% vs 0.5%; Q wave myocardial infarction, 0.5% vs 0.9%; emergency bypass surgery, 2.5% vs 3.2%) were similar for multivessel and single-vessel angioplasty. The 5-year actuarial survival rate was 93% for multivessel angioplasty and 92% for single-vessel angioplasty. Event-free survival was similar except that patients undergoing multivessel angioplasty had an 8% higher incidence of repeat coronary angioplasty in the first year of follow-up (p = 0.03). Multivessel coronary angioplasty can be performed with results comparable to those of single-vessel angioplasty with the exception of a higher incidence of repeat angioplasty.