Multivessel coronary angioplasty from 1980 to 1989: Procedural results and long-term outcome

Abstract

From June 1980 to January 1989, 3,186 patients had coronary angioplasty of two (2,399 patients) or three (787 patients) of the three major epicardial coronary systems. A mean of 3.6 lesions (range 2 to 14) were dilated per patient, with a 96% success rate. Acute complications were seen in 94 patients (2.9%) and included Q wave infarction in 47 (1.4%), urgent coronary artery bypass surgery in 33:1%) and death in 31 (1%). Multivariate correlates of in-hospital death included impaired left ventricular function, age ≥70 years and female gender.Complete long-term follow-up data were available for the first 700 patients and the follow-up period averaged 54 ± 15 months in duration. Actuarial 1 and 5 year survival rates were 97% and 88%, respectively, and were not different in patients with two or three vessel disease. By Cox regression analysis, age ≥70 years, left ventricular ejection fraction ≤40% and prior coronary artery bypass surgery were associated with an increased mortality rate during the follow-up period.Repeat revascularization procedures were required in 322 patients (46%). Restenosis resulted in either repeat angioplasty or bypass surgery in 227 patients (32%). Repeat coronary angioplasty was performed for isolated restenosis in 126 patients (18%), for restenosis and disease progression at new sites in 85 patients (12%) and for new disease progression alone in 54 patients (8%). Coronary bypass surgery was required in 110 patients (16%) during the follow-up period. The actuarial 4 year repeat revascularization rate for patients with complete and incomplete revascularization was 74% and 33%, respectively (p = 0.03). At follow-up study, 67% (412 of 700) of patients were free of angina and 19% had class II angina.Thus, multivessel coronary angioplasty was safe and effective and resulted in excellent long-term symptom relief and survival. Although repeat coronary angioplasty for restenosis or new disease, or both, was performed in 38% of patients, only 16% of patients required bypass surgery.