Open AccessPercutaneous transluminal coronary angioplasty in multivessel coronary disease patients: Short‐ and long‐term follow‐up in single and multiple dilatations
Author(s) -
Dorros G.,
Lewis R. F.,
Mathiak L. M.
Publication year - 1988
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960110904
Subject(s) - medicine , ejection fraction , bypass surgery , cardiology , angioplasty , myocardial infarction , percutaneous transluminal coronary angioplasty , revascularization , lesion , surgery , coronary artery bypass surgery , artery , heart failure
Transluminal coronary angioplasty was successfully performed in 658 of 752 patients with multivessel disease. An angiographic success was achieved in 1198 of 1358 lesions (88%). One lesion was attempted in 338 patients (45%); 2 in 273 (37%); 3, in 101 (13%); and, 4 or more in 40 cases (5.3%). Significant complicatsions occurred in 39 patients (5.2%): 19 (2.5%) had a transmural infarction; 26 (3.5%) required urgent myocardial revascularization; and 14 (1.9%) died. An apparent lesion recurrence occurred in 233 of 658 (35%) patients with 162 of 171 (95%) having a successful second coronary angioplasty. A second apparent lesion recurrence occurred in 37 of 162 patients (23%) with 24 of 28 (86%) having a successful third coronary angioplasty. Clinical improvement (mean follow‐up: 31 ± 17 months) persisted in 81% of successful patients. The cumulative probability of survival was 91.5% at 72 months. Survival was adversely affected, at 63 months, by the presence of prior bypass surgery (no prior bypass surgery, 94% vs. prior bypass surgery, 86%; p<0.05): at 24 months by a low left ventricular ejection fraction (≤35%, 82% vs. left ventricular ejection fraction >35%, 95%; p<0.01) and, at 57 months, in the multiple dilatation group with prior bypass surgery (no bypass surgery 96% vs. prior bypass surgery 84%; p<0.05). Multiple dilatation had a beneficial effect upon survival, at 27 months, in patients with a left ventricular ejection fraction ≤35% [single dilatation, 74% vs. multiple dilatation, 93%; p<0.001], and in patients ≥70 years, at 39 months (79% vs. multiple dilatation, 92%; p<0.01). These data suggest that coronary angioplasty can be an effective treatment in patients with multivessel coronary disease without the need to dilate all diseased vessels, with good success, acceptable complication rates, and a reasonable expectation of satisfactory long‐term clinical improvement.