Therapy and Prevention Angioplasty

There is controversy regarding the application of angioplasty to patients with multivessel disease in whom all significant stenoses are not dilated. We analyzed the outcomes of 286 patients with multivessel disease and prior successful angioplasty at a mean follow-up duration of 26.2 months. End points analyzed included death, myocardial infarction, late revascularization, and angina pectoris. After successful angioplasty, 127 patients had no residual stenoses of 70% or greater (group 1) and 159 patients had one or more residual stenoses of 70% or greater (group 2). Because there were significant differences in baseline risk factors between the two groups, a logistic regression model was used to make the necessary adjustments in the analysis. Adjusted estimates of the risk of death, death/myocardial infarction, or presence of angina pectoris did not differ between the two groups. Group 2 patients, however, had more coronary artery bypass surgery during follow-up, while those in group 1 had more second PTCA procedures. Results suggest that angioplasty can be safely applied to patients with multivessel disease, even when all significant stenoses are not dilated. Circulation 77, No. 3, 638-644, 1988. WHILE percutaneous transluminal coronary angioplasty (PTCA) is the revascularization procedure of choice for patients with single-vessel disease, definitive criteria for its application in patients with multivessel coronary disease are still in evolution. Despite the increasing application of PTCA in these patients, there is concern regarding the long-term effects of the procedure, especially when all stenoses are not dilated. Several studies of both angioplasty1' 2 and surgical therapy3-7 have suggested a poorer outcome in the latter cases. This report from the NHLBI PTCA registry was designed to further assess the influence of the degree of revascularization in patients with multivessel corFrom the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN. Clinical centers contributing to the NHLBI Percutaneous Transluminal Coronary Angioplasty Registry are listed in an Appendix appearing before the references. Address for correspondence: Guy S. Reeder, M.D., Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First St., SW, Rochester, MN 55905. Received Sept. 16, 1987: revision accepted Nov. 20, 1987. 638 onary artery disease who underwent successful angioplasty. Outcome measures selected for analysis included death, myocardial infarction, angina, and need for bypass surgery or repeat angioplasty.