Coronary angioplasty of diffuse coronary artery disease

Abstract

From January 1983 through December 1987, 98 patients underwent angioplasty of at least one diffusely diseased coronary artery. Diffuse coronary disease was described as: group I, narrowing greater than or equal to 50% that involved the entire vessel (40 patients), group II, long lesions greater than or equal to 2 cm in length (39 patients), group III, three or more lesions in the same vessel (19 patients). There were 65 men and 33 women, with a mean age of 60 years; 64 patients (65%) had unstable angina, 23 patients (23%) were diabetic, 31 (32%) had prior myocardial infarctions, and 12 had prior bypass surgery. Multivessel disease was present in 89% of patients. Angioplasty of only the diffusely diseased vessel was performed in 41 patients, and additional vessels were dilated in 57 patients. Overall, of 396 lesions (four per patient) and 197 vessels (two per patient) attempted, success was achieved in 382 lesions (96%) and 187 vessels (95%); angiographic success was achieved in 112 of 120 diffusely diseased vessels (93%). Clinical success was achieved in 91 patients (93%). The overall complication rate (death, myocardial infarction, urgent bypass surgery) was 8% (8 of 98): six patients (6%) had myocardial infarction (one Q wave, five non-Q wave), one patient (1%) had urgent bypass surgery, and two patients (2%) died (one during bypass surgery). The majority of complications (7 of 8 or 87%), including the two deaths, occurred in group I patients, with a 17.5% rate, versus 2.5% in group II and 0% in group III,p < 0.002. Late follow-up data were available for 86 of 91 (95%) of successfully treated patients and ranged from 12 to 69 months (mean 29 months). Clinical recurrence occurred in 27 patients (31%): restenosis of the diffusely diseased vessel was present in 24 patients, and three patients had restenosis of another vessel. Restenosis was treated by repeat angioplasty in 22 of 27 (81%) patients. Late myocardial infarction occurred in four patients (5%), and four patients (4.4%) died of cardiac causes during the follow-up period. Clinical recurrence and follow-up events were comparable for the three groups. Including those who had repeat angioplasty, 72 patients (84%) maintained clinical improvement without myocardial infarction or bypass surgery during the follow-up period. Actuarial survival was 93% at 36 months, and event-free survival (free of myocardial infarction, bypass surgery) was 82% at 3 years after angioplasty. Thus angioplasty of diffuse coronary disease is safe and effective in selected patients. Immediate success and clinical recurrence rates are similar to results reported with angioplasty for discrete lesions; However, the complication rate is higher and appears to be more frequent in the subgroup of patients with disease that involves the whole length of the vessel (group I).