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[Multivessel PTCA as an alternative to bypass operation: effect of complete revascularization on long-term follow-up]
H Seggewiss1, D Fassbender, J Vogt
1Kardiologische Klinik, Herzzentrum NRW, Bad Oeynhausen.
Insights
Multivessel percutaneous transluminal coronary angioplasty (PTCA) shows good initial results for treating coronary artery disease. Complete revascularization did not significantly improve clinical outcomes compared to incomplete revascularization.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Coronary artery disease management often involves revascularization strategies.
- Percutaneous transluminal coronary angioplasty (PTCA) is an alternative to coronary artery bypass grafting (CABG) for multivessel disease.
- The impact of initial revascularization completeness on long-term outcomes requires further investigation.
Purpose of the Study:
- To evaluate the influence of initial revascularization completeness on clinical follow-up after multivessel PTCA.
- To compare clinical outcomes between patients who achieved complete versus incomplete revascularization via PTCA.
Main Methods:
- A cohort of 231 patients undergoing multivessel PTCA between 1985 and 1989 was analyzed.
- Patients were divided into complete (Group A) and incomplete (Group B) revascularization groups.
- Clinical follow-up was obtained via questionnaire at approximately 20 months post-procedure.
Main Results:
- Successful PTCA was achieved in 86% of patients, with complete revascularization in 71% (Group A) and incomplete in 28% (Group B).
- Both groups showed similar rates of continuous clinical improvement (70% vs. 68%).
- Patients with incomplete revascularization (Group B) experienced significantly more subsequent CABG (12% vs. 3%) and repeat angioplasty (7% vs. 1%) (p<0.05).
Conclusions:
- Multivessel PTCA demonstrates favorable primary results and low risk.
- While complete revascularization is desirable, incomplete revascularization did not lead to significantly worse overall cardiac events in this cohort.
- However, incomplete revascularization was associated with a higher need for subsequent revascularization procedures.
Abstract:
In this study we examine the influence of the initial grade of revascularisation on clinical follow-up in patients with multivessel PTCA instead of CABG. Between I/85 and VII/89 multivessel PTCA was performed in 231 patients (202 m, 29 w; age 57 +/- 9 years). 71% of the patients had 2-vessel disease (VD), 14% 3-VD. 15% had angioplasty of one major and at least one important side branch. Clinical follow-up was achieved by a questionnaire 19.8 +/- 10.1 months after PTCA. 473 of 508 (93.1%) treated stenoses were successfully (residual stenosis less than 50%). 198 patients (86%) had successful angioplasty of all treated lesions. 31 patients (13%) had failed PTCA of one stenosis, 1 patient of both treated lesions. 1 patient underwent emergency CABG. A complete revascularisation (group A) - no residual stenosis greater than 50% in any coronary artery - was achieved in 164 patients (71%). 65 patients (28%) had incomplete revascularisation [group B]. 206 patients (89.1%) had clinical follow-up by questionnaire, 144 patients in group A (87.8%) and 60 patients in group B (92.3%) [n.s.]. 3 patients had died by noncardiac reasons (two in group A and one in group B), 1 patient of group A by cardiac reason. 70% in group A and 68% in group B had continuous clinical improvement (n.s.). Total amount of cardiac events (PTCA, CABG, cardiac death, MI) showed no significance between both groups - 35 (24%) vs 23 (38%). Patients in group B had more CABG (12% vs 3%) and angioplasty of further lesions (7% vs 1%) [p less than 0.05] during follow-up. We conclude multivessel PTCA shows good primary results with low risk.(ABSTRACT TRUNCATED AT 250 WORDS)