Coronary angioplasty in multivessel disease. Complete vs incomplete revascularization. Results and follow-up

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Abstract

In order to evaluate the impact of achieved complete revascularization (CR) by percutaneous transluminal coronary angioplasty (PTCA) in multivessel disease (MD), we reviewed the incidence of major events [death (D), myocardial infarction (MI)], angina (A) and the need of new revascularization procedures in the mid- term follow up (FU) in 321 consecutive patients done in our institute since 1988. The angiographic findings were two vessel disease 257 patients (80,1 %), three vessel disease 64 patients (19.9 %) and left main disease in two patients (0.7 %). We performed single PTCA in 239 patients (74.5 %), double PTCA in 76 patients (23.7 %), triple PTCA in four patients (1.2 %) and protected left main PTCA in two patients. We made 448 dilatations achieving a primary success of 89.7 % (288/321). The complications were MI: 2.2 % (7 patients), emergency coronary by pass surgery 0.90;. (3 patients),D 1.2 % (4 patients). We obtained CR in 121 patients (42%). We had a mean FU of 8.05 ± 3.1 months in CR and 6.07 ± 2.8 months in the incomplete revascularization (IR) group (G). Follow up results: CR: there were 4 D (4 %), 2 MI (2 %), clinic recurrence (CI R) in 35 patients (35 %) due to restenosis (Res) in 31 patients and new lesions (NL) in four patients. From the 31 patients with CI R for Res 6 (19.4 %) required CABG, 20 (64.5 %) were redilated (Red) and 5 (16.1 %) begun medical treatment (MT). The 30 months survival rate was 90.6  ±. 6.19 % (SE) and 54.9 ±. 6.28 % (SE) of patients are free of MI, CABG, Red and MT. IR: There were 2 0 (1.7 %), 2 MI (1.7 %), CI R in 42 patients (35 %), due to Res in 34 patients (28.3 %) and NL in 8 patients (6.6 %). From the 34 patients with CI R for Res 10 (29.4%) required CABG, 17 (50%) were Red and 7 (25 %) begun MT. The patients without Res 20.5 % had angina (p < 0.04), the half due to NL and in the rest of them incomplete revascularization. The 33 months survival rate was 97.2 ±. 1.5 % (SE) and 56.3 ±. 7.4 % (SE) of patients are free of MI, CABG, Red and MT. The incidence of previous MI for the CR G was 57 % and for the IR G was 20.4 % (p < 0.0001). The 30 months survival rate for patients without previous MI was 98.6 ±. 0,9 % (SE) and 86.9 ± 6.8 % (SE) for the G with previous MI (p < 0.03). Conclusion: The PTCA in MD is performed with high primary success and low rate of complications achieving CR only in half of the patients, however this not changed the midterm outcome, except for more angina in IR G.