[Percutaneous transluminal coronary angioplasty in coronary multivessel disease: clinical course in relation to degree of functional revascularization].
In this prospective nonrandomized study, we analyzed the influence of the degree of revascularization--determined by anatomic, morphologic, and functional criterias--on clinical follow-up after PTCA in patients with multivessel disease. 283 patients (74% with double vessel disease, 26% with triple vessel disease; mean age 59.2 +/- 8.2 years; 250 (88%) men) were treated. Clinical successful PTCA was achieved in 247 patients (87.2%): in 239 patients (84.4%) all attempted lesions and in 8 patients (2.8%) at least the culprit lesions were successfully dilated. Complications were seen in 15 patients (5.3%): seven patients underwent emergency bypass surgery, one patient had bypass surgery 8h after PTCA because of an early re-occlusion, five patients suffered an acute myocardial infarction during PTCA, and two patients, who had PTCA because of cardiogenic shock, died during PTCA. Post PTCA, 39 patients (13.8%) had anatomic complete (AK), 35 patients (12.4%) anatomic incomplete but functional complete (FK), 148 patients (52.3%) anatomic incomplete but functional adequate (FA), and 46 patients (16.2%) anatomic and functional incomplete (IR) revascularization. All patients had follow-up after 30.5 +/- 5.5 months. Fifteen patients (5.3%) died, 15 patients (5.3%) suffered a myocardial infarction, and 39 patients (13.8%) underwent an elective bypass operation during follow-up. Cumulative 2-year survival and cumulative 2-year infarct-free survival were not influenced by the degree of revascularization. In contrast to that, the cumulative 2-year bypass-free survival was significant lower in patients with IR (71.0%) compared to patients with AK (92.5%; p < 0.01), FK (89.3%; p < 0.05), and FA (92.7%; p < 0.001). Patients with IR were more likely to have PTCA of previous untreated lesions and were often less likely to have clinical improvement compared to the other subgroups. Thus, in patients with multivessel disease PTCA is a therapeutic option if AK, FK, and FA revascularization can be achieved. Provided that just an IR revascularization can be achieved by PTCA, angioplasty should be performed only for treatment of acute ischemic syndromes in order to improve clinical symptoms. Otherwise, an increased incidence of further revascularization procedures and a reduced clinical improvement can be expected.
Seggewiss
H
H
Kardiologische Klinik, Herz- und Diabeteszentrum NRW, Universitätsklinik, Ruhr-Universität Bochum, Bad Oeynhausen.
Gleichmann
U
U
Fassbender
D
D
Schmidt
H K
HK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D003326:Coronary Circulation / Q000502:physiology*; D003327:Coronary Disease / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D017202:Myocardial Ischemia / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D012008:Recurrence; D015996:Survival Rate
Perkutane transluminale Koronarangioplastie bei koronarer Mehrgefässerkrankung: Klinischer Verlauf in Abhängigkeit vom funktionellen Revaskularisationsgrad.