Late outcome of multivessel coronary artery disease after angioplasty or bypass surgery.
Background.  Results from randomized trials to determine optimal treatment for patients with multivessel coronary disease are not yet available.  Thus, the early and late outcomes of 191 PTCA and 221 CABG patients done in 1985-86 were evaluated.  Methods and Results.  CABG patients selected had more coronary risk factors and more severe coronary artery disease compared to PTCA patients.  Comparison of the initial outcome showed that clinical success without major cardiovascular events was similar (93.7% for PTCA vs. 90.0% for CABG; p=n.s.).  Five year followup was obtained in 99.0% of PTCA patients and 94.4% of CABG patients.  In the PTCA group, 89.8% were alive, 4.8% had sustained an MI, and repeat revascularization was required in 46.8%.  In the CABG group, 87.1% were alive, 3.2% had had a MI, and 3.5% required repeat revascularization.  Statistical comparison demonstrated no difference between the groups in survival or late cardiac events, but rate of repeat revascularization was significantly higher for PTCA patients (p less than 0.0001).  Incompleteness of revascularization (p<0.01) was independently associated with an increased need for repeat revascularization in the PTCA group.  In the CABG group, depressed left ventricular function (p less than 0.001) and female sex (p<0.01) were associated with lower survival rates.  An analysis of cost per patient showed that the strategies were comparable. Conclusions.  PTCA and CABG in multivessel disease patients have similar early results and comparable rates of survival and late cardiac events.  Significantly more repeat revascularization is required in PTCA patients to maintain these results.(ABSTRACT TRUNCATED AT 250 WORDS)
San Francisco Heart Institute at Seton Medical Center, Daly City, California.
P A
PA
Baciewicz
R E
RE
Shaw
J
J
Rosenblum
R K
RK
Myler
A
A
Zapolanski
A
A
Anwar
S H
SH
Stertzer
M C
MC
Murphy
H N
HN
Hansell
J
J
Chan
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000191:economics / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000191:economics / Q000379:methods; D003324:Coronary Artery Disease / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome