ONE-YEAR FOLLOW-UP RESULTS OF CULPRIT VERSUS MULTIVESSEL CORONARY ANGIOPLASTY TRIAL

Since its introduction 16 years ago, percutaneous transluminal coronary angioplasty (PTCA) has increasingly been applied to patients with multivessel coronary artery disease1-4 with steadily improving results. The approach to such patients may involve attempted dilation of all significant stenoses in an attempt to achieve complete revascularization. An alternative strategy that might carry lower procedural risk is identifying and dilating only the "culprit" stenosis, i.e., the stenosis judged responsible for the patient's ischemic manifestations.5-7 Enthusiasm for such an approach has been tempered by studies showing that patients who have undergone incomplete revascularization with PTCA have a higher incidence of recurrent angina and more often require repeated revascularization procedures. 8-13 However, not all studies have shown such results, 14 and a recent study found that when baseline differences from patients with complete and incomplete revascularization are taken into account, the completeness of revascularization does not influence late outcome. 15 We undertook a randomized trial of culprit versus multivessel PTCA in patients with multivessel coronary disease in order to determine whether there were any differences in acute procedural outcome or in clinical status 1 year later. © 1993.