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Triple vessel coronary angioplasty: acute outcome and long-term results
G DiSciascio1, M J Cowley, G W Vetrovec
1Department of Medicine, Medical College of Virginia, Richmond 23298.
Insights
Triple vessel coronary angioplasty successfully treated severe three-vessel coronary artery disease in 50 patients, achieving high rates of angiographic and clinical success with low incidence of urgent bypass surgery.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Surgery
Background:
- Triple vessel coronary artery disease (CAD) affects a significant portion of patients requiring revascularization.
- Previous coronary bypass surgery and myocardial infarction are common comorbidities in patients with severe CAD.
- Unstable angina and severe symptoms (Canadian Heart Association class III or IV) are prevalent in this patient group.
Purpose of the Study:
- To evaluate the efficacy and safety of triple vessel angioplasty in patients with severe three-vessel coronary artery disease.
- To determine the rates of angiographic and clinical success for this complex interventional procedure.
- To assess the incidence of adverse events, including myocardial infarction and urgent bypass surgery.
Main Methods:
- Retrospective analysis of 50 patients undergoing triple vessel angioplasty (one or more lesions in LAD, LCx, and RCA).
- Angioplasty performed on 176 vessels and 250 lesions.
- Assessment of angiographic success (lesion/vessel patency) and clinical success (angiographic success + clinical improvement).
Main Results:
- High angiographic success rates: 96% for lesions and 94% for vessels.
- 80% of patients achieved success in all attempted vessels.
- 100% clinical success with no urgent bypass surgery required; 10% experienced non-Q wave myocardial infarction.
Conclusions:
- Triple vessel angioplasty is a highly effective revascularization strategy for selected patients with severe three-vessel coronary artery disease.
- The procedure demonstrates excellent clinical outcomes with a low risk of major complications.
- Careful patient selection and procedural execution are crucial for optimal results in complex CAD interventions.
Abstract:
Triple vessel coronary angioplasty, defined as angioplasty of one or more lesions in each of the three major coronary arteries (left anterior descending, left circumflex, right coronary artery) was performed in 50 (11%) of 469 patients who had angioplasty of multiple vessels. There were 32 men and 18 women with a mean age of 56 years. All 50 patients had severe three vessel coronary disease and represent approximately 5% of patients with three vessel disease who had revascularization in this institution; 8 (16%) had previous coronary bypass surgery, and 23 (46%) had previous myocardial infarction. Unstable angina was present in 33 patients (66%) and 96% had Canadian Heart Association class III or IV angina; mean left ventricular ejection fraction was 57 +/- 11%. Angioplasty was performed in 176 vessels (3.5 vessels per patient, range 3 to 6) and in 250 lesions (5 lesions per patient, range 3 to 9); angiographic success was achieved in 240 lesions (96%) and 166 vessels (94%). Success in all vessels attempted was achieved in 40 (80%) of the 50 patients. Clinical success (angiographic success associated with clinical improvement) was obtained in all 50 patients in whom triple vessel angioplasty was performed; none of them required urgent bypass surgery and 5 patients (10%) had a non-Q wave myocardial infarction. In four other patients triple vessel angioplasty was planned but not performed because of failure to dilate the primary vessel; urgent bypass surgery was required in one of these, who developed a Q wave infarction. Thus, overall clinical success in 54 patients was 93%; the incidence rate of myocardial infarction was 11%, and that of urgent surgery 1.8%.(ABSTRACT TRUNCATED AT 250 WORDS)