Comparison of percutaneous transluminal coronary angioplasty versus coronary artery bypass grafting for multivessel coronary artery disease

Abstract

Percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) are both widely performed in the treatment of multivessel coronary artery disease. Little data directly compare the outcomes of patients treated with these 2 techniques. We examined the characteristics and outcomes of 152 patients who underwent multivessel PTCA and 134 patients who had multivessel CABG. Patients who had prior PTCA or CABG were excluded. Baseline characteristics such as age, sex, and prior myocardial infarction were similar in the 2 groups. Ejection fraction was significantly lower in the CABG group (48 ± 14%) versus the PTCA patients (53 ± 15%) (p = 0.002). Narrowing distribution when analyzed by major vascular beds (left anterior descending, circumflex and right coronary arteries) as well as by individual arteries was not significantly different between the groups when left main stenosis was excluded. The surgical group received a larger number of bypasses per patient (3.9) when compared with narrowings dilated in the angioplasty group (3.7) (p < 0.001). The left internal mammary artery was used in 75% of patients as one of the grafts. Angioplasty success was 95% by standard criteria. Over a mean follow-up of 110 weeks for PTCA patients and 134 weeks for CABG patients the occurrence of death was similar (10 and 14%, respectively) as was myocardial infarction (4 and 2%, respectively). However, all other cardiac events including subsequent cardiac catheterization (49 vs 10%), PTCA (30 vs 2%) and CABG (23 vs 2%) occurred significantly more often in the PTCA group (all p < 0.001). Of the 152 PTCA patients, 74 (49%) underwent repeat catheterization once, 26 (17%) twice, 8 (5%) 3 times, and 4 (3%) 4 times. At the time of final follow-up, 87% of surviving patients in the CABG group were angina-free and 84% had negative treadmill test results, whereas these findings were seen in 78 and 73% of PTCA patients, respectively (p < 0.02 for a significant difference in these indicators of recurrent ischemia between the 2 groups), despite the greater number of intervening procedures in the PTCA group. It is concluded that although both PTCA and CABG can provide good symptomatic relief for patients with multivessel coronary artery disease, with comparable midterm survival rates, a need for repeat interventions occurs significantly more often in patients of this type undergoing angioplasty as opposed to those undergoing surgery, with greater evidence of residual or recurrent ischemia in those who received PTCA.