LATE RESULTS OF PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY OF 2 OR MORE MAJOR NATIVE CORONARY-ARTERIES

Of 613 consecutive patients with multivessel coronary artery disease (CAD) undergoing revascularization, 521 patients (85%) underwent primary management with percutaneous transluminal coronary angioplasty (PTCA). To examine long-term outcome in a series of patients often referred For coronary artery bypass graft (CABG) surgery, all patients undergoing multivessel dilations were identified for late follow-up analysis (n=161). Mean age was 65 years; 54 patients (34%) were women. Four hundred fifty-five of 502 lesions (90.6%) were successfully dilated. Major in-hospital procedural complications occurred in 6 patients (3.7%), including death in 3 (1.9%), nonfatal Q-wave myocardial infarction in 2 (1.2%), and CABG in 1 (0.6%). Final follow-up data were available in 159 patients (99%) at a mean of 39+/-18 months. including in-hospital events; actuarial 3-year survival was 93%, and 3-year infarct-free,survival was 90%. At final follow up, 143 of 146 patients alive (98%) were angina free. Crossover to CABG was required in 25 patients (16%). Repeat PTCA was performed in 67 patients (42%) (mean 1.7 PTCAs/patient, range 1 to 7). PTCA is an effective therapeutic alternative in the management of most patients with multivessel GAD requiring revascularization. A strategy using multiple repeated PTCA procedures when necessary results in prolonged infarct free survival, with long-term freedom from angina and limited crossover to CABG.