Triple vessel coronary angioplasty: Acute outcome and long-term results

Abstract

Triple vessel coronary angioplasty, defined as angioplasty of one or more lesions in each of the three major coronary arteries (left anterior descending, left circumflex, right coronary artery) was performed in 50 (11%) of 469 patients who had angioplasty of multiple vessels. There were 32 men and 18 women with a mean age of 56 years. All 50 patients had severe three vessel coronary disease and represent approximately 5% of patients with three vessel disease who had revascularization in this institution; 8 (16%) had previous coronary bypass surgery, and 23 (46%) had previous myocardial infarction. Unstable angina was present in 33 patients (66%) and 96% had Canadian Heart Association class III or IV angina; mean left ventricular ejection fraction was 57 ± 11%.Angioplasty was performed in 176 vessels (3.5 vessels per patient, range 3 to 6) and in 250 lesions (5 lesions per patient, range 3 to 9); angiographic success was achieved in 240 lesions (96%) and 166 vessels (94%). Success in all vessels attempted was achieved in 40 (80%) of the 50 patients. Clinical success (angiographic success associated with clinical improvement) was obtained in all 50 patients in whom triple vessel angioplasty was performed; none of them required urgent bypass surgery and 5 patients (10%) had a non-Q wave myocardial infarction. In four other patients triple vessel angioplasty was planned but not performed because of failure to dilate the primary vessel; urgent bypass surgery was required in one of these, who developed a Q wave infarction. Thus, overall clinical success in 54 patients was 93%; the incidence rate of myocardial infarction was 11%, and that of urgent surgery 1.8%.All 50 patients who had successful triple vessel angioplasty were followed up > 6 months (range 6 to 63, mean 18.4). Clinical recurrence developed in 17 patients (34%), of whom 15 had successful repeat angioplasty and 2 (4%) underwent elective bypass surgery. Two patients (4%) had late myocardial infarction, two (4%) died suddenly and one underwent cardiac transplantation during follow-up. Actuarial event-free survival (no myocardial infarction, death or bypass surgery) was 90% at 2 years. With inclusion of the 15 patients who had repeat angioplasty, 90% of patients are in improved condition (74% are asymptomatic and 16% are in functional class I) without requiring bypass surgery during follow-up. These immediate and long-term results indicate that triple vessel angioplasty is a safe and effective therapy in selected patients with three vessel coronary disease.