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Role of percutaneous transluminal coronary angioplasty in multivessel disease

D R Holmes1, G S Reeder, R E Vlietstra

  • 1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.

The American Journal of Cardiology
|May 9, 1988
PubMed

Insights

Percutaneous transluminal coronary angioplasty (PTCA) is evaluated for multivessel disease, focusing on complete revascularization. Studies compare PTCA with coronary artery bypass grafting to define their roles in patient outcomes.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Percutaneous transluminal coronary angioplasty (PTCA) is increasingly used for multivessel disease.
  • Completeness of revascularization is crucial for improved clinical outcomes, based on cardiac surgery data.
  • Achieving complete revascularization is often challenging due to factors like total occlusions or diffuse disease.

Purpose of the Study:

  • To assess the role of PTCA in multivessel disease.
  • To evaluate factors influencing PTCA's long-term effectiveness, including procedural risks and restenosis.
  • To compare PTCA with coronary artery bypass grafting (CABG) in multivessel disease patients.

Main Methods:

  • Ongoing studies are comparing PTCA directly with CABG for multivessel disease.
  • Assessment includes immediate success rates, long-term morbidity and mortality, and cost-effectiveness.
  • Focus on identifying and dilating "culprit" lesions when complete revascularization is not feasible.

Main Results:

  • While complete revascularization is ideal, incomplete revascularization with PTCA can yield good short-term outcomes by targeting "culprit" lesions.
  • The ultimate role of PTCA depends on immediate/long-term results, risks, restenosis, and completeness of revascularization.
  • Two studies are underway to compare PTCA and CABG for multivessel disease, evaluating various outcomes.

Conclusions:

  • The comparative effectiveness of PTCA versus CABG for multivessel disease is under investigation.
  • Results from ongoing trials will clarify the complementary roles of PTCA and CABG.
  • Optimizing revascularization strategies, whether complete or targeted, is key for improving patient outcomes in multivessel disease.

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