Open AccessMultiple vessel coronary angioplasty: Classification, results, and patterns of restenosis in 494 consecutive patients
Author(s) -
Myler Richard K.,
Topol Eric J.,
Shaw Richard E.,
Stertzer Simon H.,
Clark David A.,
Fishman Jodi,
Murphy Mary C.
Publication year - 1987
Publication title -
catheterization and cardiovascular diagnosis
Language(s) - English
Resource type - Journals
eISSN - 1097-0304
pISSN - 0098-6569
DOI - 10.1002/ccd.1810130102
Subject(s) - medicine , angioplasty , restenosis , myocardial infarction , cardiology , stenosis , bypass surgery , angina , diabetes mellitus , angiography , surgery , logistic regression , coronary arteries , artery , stent , endocrinology
We report the immediate results and 6 month follow‐up data of 494 consecutive patients who underwent coronary angioplasty in two or more major epicardial arteries. Clinical success was achieved in 95% of the 494 patients. The technical success rate for the 1,117 vessels dilated was 89%, defined as at least a 35% reduction (mean = 53%) of the initial percent diameter stenosis and a decrease in the transstenotic gradient to ≤15 mmHg (mean = 9 mmHg). Complications of the procedure included emergency bypass surgery (2.8%), myocardial infarction (3.0%), and hospital death (0.4%) inclusive. At least one of these complications (major cardiac event) occurred in 3.8% of patients. Prior to angioplasty, 46% of patients were in Canadian Cardiovascular Society Class II, 42% in Class III, and 12% in Class IV. Follow‐up clinical evaluation (mean follow‐up period of 16.9 months) showed 83% of patients in Class I, 14% in Class II, and 3% in Class III. Of the 286 successful patients who have reached 6 month follow‐up plateau (mean follow‐up period of 20.5 months), 164 (57%) have so far had repeat coronary angiography and exhibited three different patterns: all lesions patent (N = 54), some lesions restenosed (N = 60), and all lesions restenosed (N = 32). There were 18 patients with new vessel lesions (not previously dilated). Logistic regression analyses demonstrated that clinical factors including diabetes (P <.05), hypercholesterolemia, (P <.01), new onset angina (P <.05), current smoking (P <.01), and morphologic and technical factors such as preangioplasty diameter stenosis > 95% (P <.05) and higher balloon inflation pressure (P <.05) were predictive of increased risk of recurrence. Patients were classified into two groups based on the anatomy of the target lesions. In Group A (N = 217), patients had a single lesion in each of the vessels to be dilated; Group B (N = 277) patients had a complex lesion in at least one of the vessels dilated. Group B patients were more likely to develop recurrence (P <.05). Of the original 494 patients, 488 (99%) are alive. Coronary angioplasty (either initially or with repeat PTCA) has been the definitive treatment in 453 of the 494 patients for an overall success of 92%. Thus multiple vessel coronary agioplasty can be performed effectively with a high angioplasty success rate and relatively low complication rate and excellent clinical prognosis. Patterns of restenosis appear to be related to clinical, morphologic, and technical factors.