[Comparison of long-term prognosis between medical therapy PTCA and CABG for multiple coronary vessel disease]

Left main trunk disease is mainly treated by CABG, on the other hand, single vessel disease is applied by Simple Medical or PTCA. These concept is widely accepted, but, there were controversies about the treatment for multiple vessel disease. The purpose of this study was to clarify the long-term prognosis of different therapeutic means for multiple vessel diseases. In our center, 3635 consecutive initial coronary angiography were done from September 1977 to December 1989. Of those, 1190 patients of multiple vessel diseases excluding those with left main trunk lesion, previous re-vascularization or acute myocardial infarction were served for this study. Double vessel disease (DVD) was 727 patients, Triple vessel disease (TVD) was 455 patients. We divided these patients into three groups according to their initial therapy. A retrospective analysis was carried out on the follow-up patients from survival rate, cardiac death free rate and cardiac event free survival rate. The cardiac death were due to acute myocardial infarction, congestive heart failure and sudden death. The cardiac event including all death, acute myocardial infarction, PTCA and CABG. The statistical analysis was done by Kaplan-Meier and Cox Proportional Hazard Model. The survival rate in DVD and TVD, Medical was significantly lower than other groups. Survival curves of CABG and PTCA was quite similar. The survival rate at 5 years was 85 (M), 89 (C) and 89% (P), and at 10 years 67,78 and 76%, respectively in DVD, and the survival rate at 5 years was 57,91 and 90%, and at 10-years, 57,77 and 78%, respectively. The cardiac death free rate in DVD and TVD showed same tendency. The cardiac event free survival in DVD, PTCA was significantly lower than other groups. This result was derived from high incidence of re-stenosis after PTCA. The cardiac event free survival rate were at 5 years 79 (M), 86 (C) and 58% (P) and at 10 years 50, 58 and 30%, respectively. In TVD, CABG was significantly higher than other groups. The cardiac event free survival rate were at 5 years 72, 86 and 63% and 10 years 42,64 and 39%, respectively. In Summary, the survival rate and cardiac death free rate of Medical were significantly lower than those of CABG and PTCA. There were no significant differences between CABG and PTCA on the survival rate and cardiac death free rate. The cardiac event free survival rate of CABG was significantly higher than that of PTCA and Medical. In multiple vessel disease, CABG will bring the best long term prognosis. Even though the cardiac events were most frequent in PTCA, it's survival rate was quite similar to CABG. So, PTCA must be thought the second best method of the therapy of multiple vessel disease.