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[Percutaneous transluminal coronary angioplasty in patients with multivessel coronary disease: does complete
Insights
Complete revascularization after percutaneous transluminal coronary angioplasty (PTCA) for multivessel coronary artery disease showed a trend toward better survival. However, incomplete revascularization did not significantly impact survival, though it increased the need for bypass surgery.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Context:
- Multivessel coronary artery disease (CAD) poses significant challenges for percutaneous transluminal coronary angioplasty (PTCA).
- The extent of revascularization, both anatomical and functional, is crucial for patient outcomes.
- Assessing the long-term impact of complete versus incomplete revascularization is vital for treatment strategies.
Purpose:
- To evaluate the 10-year survival and event-free survival in patients with multivessel CAD undergoing PTCA.
- To determine the influence of complete revascularization compared to incomplete revascularization on long-term outcomes.
- To explore the role of functional revascularization adequacy in patient prognosis.
Summary:
- A 10-year analysis of 167 patients with multivessel CAD treated with PTCA compared complete (n=49) and incomplete (n=118) revascularization.
- While 10-year survival was slightly higher in the complete revascularization group (100% vs. 79%, p=0.089), this difference was not statistically significant.
- The need for subsequent coronary artery bypass surgery was significantly higher in the incomplete revascularization group (100% vs. 81%, p=0.013).
Impact:
- Complete revascularization may offer a survival benefit in multivessel CAD patients treated with PTCA, although not statistically significant in this cohort.
- Incomplete revascularization significantly increases the likelihood of requiring coronary artery bypass grafting later.
- Further investigation into functional revascularization status in larger populations is warranted to clarify its impact on outcomes.
Abstract:
The influence of complete revascularization on long-term outcome of patients with multivessel coronary artery disease undergoing percutaneous transluminal coronary angioplasty (PTCA) was determined by analysis of 10-year survival in 167 consecutive patients treated at Juntendo University Hospital during 1984-1993. Forty-nine patients were completely revascularized and 118 had incomplete revascularization according to the anatomical classification. Among patients with anatomically incomplete revascularization, 56 were categorized as functionally adequate revascularization and 62 as functionally inadequate revascularization according to Faxon's criteria. Baseline characteristics showed incompletely revascularized patients had a higher incidence of prior myocardial infarction triple-vessel disease and/or chronic total occlusion in at least one lesion. The 10-year survival was slightly better in patients with complete (100%) than in those with incomplete revascularization (79%), but not statistically significant (p = 0.089). Event-free survival was not significantly different between the two groups. However, the need for coronary artery bypass surgery was higher in the incomplete revascularization group than that in the complete revascularization group (100% vs 81%, p = 0.013). The influence of the degree of functional revascularization on outcome was not clear in the present study. Long-term survival appeared to be better in patients with complete revascularization than that in patients with incomplete revascularization, but even in the latter, coronary artery bypass grafting in the later period could improve outcome. The effect of functional revascularization status should be further investigated in a larger population.