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Successful multiple segment coronary angioplasty: effect of completeness of revascularization in single-vessel
M Samson1, H J Meester, P J De Feyter
1Catheterization Laboratory, Thoraxcenter, Erasmus University, Rotterdam, The Netherlands.
Insights
Multiple dilatations for coronary artery disease offer rewarding symptomatic improvement. Completeness of revascularization in multivessel disease is a key prognostic factor, impacting long-term outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Percutaneous coronary interventions (PCI) have evolved, with multiple dilatations becoming a common strategy.
- Evaluating the long-term efficacy of multiple dilatations based on procedural and anatomical factors is crucial for optimizing patient care.
Purpose of the Study:
- To assess the long-term value of multiple dilatations in coronary artery disease.
- To compare outcomes between single-vessel multilesion and multivessel dilatation strategies.
- To analyze the impact of complete versus incomplete revascularization in multivessel disease.
Main Methods:
- A long-term follow-up study of 248 patients who underwent successful multiple dilatations (2-4 lesions) between 1980-1988.
- Patients were categorized into single-vessel multilesion and multivessel groups.
- Anatomic subgroups included complete and incomplete revascularization within the multivessel disease cohort.
- End points: death, myocardial infarction, redilatation, bypass surgery, and symptomatic status.
Main Results:
- No significant differences in death, myocardial infarction, redilatation, or bypass surgery between single-vessel multilesion and multivessel groups (4.5-year event-free survival: 68% vs. 70%).
- Incomplete revascularization in multivessel disease was associated with significantly lower event-free survival (44%) compared to complete revascularization (78%) and single-vessel disease (74%), driven by higher rates of infarction and bypass surgery.
- Symptomatic improvement (angina relief) was excellent (>85%) across all groups, with similar rates of asymptomatic patients, except for a lower proportion of patients free from antianginal drugs in the incomplete revascularization group.
Conclusions:
- Completeness of revascularization is a critical prognostic variable in multivessel coronary artery disease.
- Despite prognostic differences, multiple dilatations provide significant and rewarding symptomatic improvement for all patient subsets.
- Multiple dilatations remain a valuable treatment strategy for selected patients with coronary artery disease.
Abstract:
A long-term follow-up study was performed to evaluate the long-term value of performing multiple dilatations according to their procedural (single-vessel multilesion or mutltivessel dilatations) and anatomic types (single-vessel disease with multiple dilatations or multivessel disease dilatations with complete and incomplete revascularization). From 1980 until 1988, 248 patients met the following criteria: (1) at least two lesions dilated (range: 2 to 4) and (2) all attempted lesions successfully dilated. The mean length of follow-up was 33 months. The end points analyzed were death, myocardial infarction, redilatation, and bypass surgery. No differences were found for these events between the single-vessel multilesion group (144 patients) and the multivessel group (104 patients). The 4.5-year probability of event-free survival was 68% and 70%, respectively, for the multilesion group and the multivessel group. In the event-free patients, 57% versus 59% were asymptomatic and 45% versus 46% were not taking antianginal drugs. In the anatomic subgroups, there were less event-free patients in the cohort of incompletely revascularized multivessel disease patients (55% of 55 patients) when compared with the cohort of those who were completely revascularized (84% of 79 patients) or when compared with the single-vessel disease multiple dilatation patients (74% of 107 patients). The 4.5-year event-free survival probability for each group was 44%, 78%, and 74%, respectively. This difference was caused by more infarctions (9% versus 2% versus 4%, respectively) and bypass operations in the multivessel disease, incomplete revascularization group (20% versus 5% versus 10%, respectively). In event-free patients, improvement of angina was similar and was documented in over 85% of patients in each group. Furthermore, the number of asymptomatic patients at follow-up was similar in all groups except that within the incomplete revascularization group, less patients were free of antianginal drugs (21% versus 51% versus 48%). Finally, 48% of the entire cohort performed an exercise test 4.6 months (mean) after dilatation and no difference was found in any of the variables in any group. About 10% of the patients experienced angina and approximately 30% had a positive exercise test for ischemia by ST segment criteria. The functional performance in every group was over 90% of the predicted work load. These results suggest that completeness of revascularization in multivessel disease patients is an important prognostic variable. However, the symptomatic improvement after dilatation is very rewarding in all subsets of patients and argues in favor of the continued use of multiple dilatations as a treatment strategy.