Percutaneous Coronary Intervention

Abstract

Objective. Toevaluate therelationship between the completeness ofrevascularisation bypercutaneous coronary intervention andtheone-year occurrence ofadverse cardiac events inpatients withmultivessel disease. Patients. Patients withstable orunstable angina pectoris, orwithexercise-induced ischaemia, were enrolled intheCoronary Angioplasty versus Bypass Revascularisation Investigation (CABRI). Methods. InCABRI,patients wererandomised to coronary bypass grafting (CABG;n=513)or angioplasty (PTCA;n=541). Revascularisation in patients randomised toPTCA wasdefined as complete ifnolesions withadiameter stenosis <50%remained post-procedure. Patients with complete revascularisation weredistinguished from those withone, two,andthree ormoreremaining lesions, respectively. Differences inbaseline characteristics andintheone-year occurrence ofdeath, myocardial infarction, (re)CABG, and(re)PTCA between these subgroups wereevaluated. Comparisons weremadewithpatients randomised to CABG. Complete revascularisation wasobtained in148patients randomised toPTCA(27%). In 147(27%) cases onelesion remained, while there were122(23%) and119(22%) patients withtwo andthree ormoreremaining lesions, respectively. Five (1%)patients could notbeclassified. Theoneyearrates ofeither death orMIwere9.5%, 5.4%, 8.2%, and12.6% intherespective PTCAsubgroups (p=0.225), and6.2%inpatients randomised to CABG(comparison withthree ormoreremaining lesions after PTCA:p=0.017). Thepercentages of repeat interventions during one-year follow-up were29.7%, 29.3%, 39.3%, and51.3% (p<0.001), muchhigher thanafter CABG(3.5%; p<0.001). Conclusion. Complete revascularisation byPTCA inmultivessel coronary disease didnotresult ina lower death orMIrate compared withincomplete revascularisation. Overall thepatient's prognosis after PTCAissimilar toCABG,butpatients with three ormoreremaining lesions after PTCAhad aworseprognosis thanCABG patients. (Neth HeartJ2001;9:3-9.)