Comparison of percutaneous transluminal coronary angioplasty versus coronary artery bypass grafting for multivessel coronary artery disease.
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 less than 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 less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
Vacek
J L
JL
Mid-America Heart Institute, Kansas City, Missouri.
Rosamond
T L
TL
Stites
H W
HW
Rowe
S K
SK
Robuck
W
W
Dittmeier
G
G
Beauchamp
G D
GD
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016019:Survival Analysis; D016896:Treatment Outcome