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Long-term outcome of patients with incomplete vs complete revascularization after multivessel PTCA. A report from the

M G Bourassa1, W Yeh, R Holubkov

  • 1Montreal Heart Institute, Quebec, Canada.

European Heart Journal
|March 21, 1998
PubMed

Insights

Incomplete revascularization after percutaneous transluminal coronary angioplasty (PTCA) for multivessel coronary disease may not increase long-term adjusted risks of death or major cardiac events. However, it does reduce the need for later coronary artery bypass grafting (CABG).

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Public Health

Background:

  • Multivessel coronary disease often results in incomplete revascularization after percutaneous transluminal coronary angioplasty (PTCA).
  • The long-term consequences of this common PTCA strategy are not well understood.
  • Further investigation into the implications of incomplete revascularization is warranted.

Purpose of the Study:

  • To evaluate the long-term impact of complete versus incomplete revascularization in patients with multivessel coronary disease undergoing PTCA.
  • To compare clinical outcomes, including mortality, myocardial infarction, recurrent angina, and repeat revascularization procedures, between the two groups.

Main Methods:

  • Analysis of data from the 1985-86 NHLBI PTCA Registry, including 757 patients with multivessel disease.
  • Comparison of baseline characteristics and long-term outcomes (9-year follow-up) between patients who achieved complete revascularization and those who did not.
  • Statistical analysis to determine adjusted risks for various clinical events.

Main Results:

  • Complete revascularization was achieved in 132 patients. Patients with incomplete revascularization were older, more likely female, and had more acute coronary syndromes.
  • Incomplete revascularization was associated with higher early rates of emergency and elective coronary artery bypass grafting (CABG).
  • At 9 years, adjusted risks for death, Q wave myocardial infarction, recurrent angina, and repeat PTCA were similar between complete and incomplete revascularization groups, although incomplete revascularization patients had more recurrent angina and underwent more CABG procedures.

Conclusions:

  • Complete revascularization achieved via PTCA reduces the late need for CABG but does not significantly alter adjusted rates of death, Q wave myocardial infarction, recurrent angina, or repeat PTCA in multivessel coronary disease.
  • These findings support the strategy of incomplete revascularization when complete revascularization is not feasible or planned during PTCA for multivessel disease.
Abstract

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