Volume 124 Number
37.
38.
39.
40.
41.
Long-term follow-up
5
and long-term outcome. J Am Co11 Cardiol1990;16:1097-1102. Burton JR, Haraphongse M, Hsu L, Kappagoda CT, Rossall RE, Schlaut B, Senaratne MPJ. Risk stratification after percutaneous transluminal coronary angioplasty. Cardiovasc Drug Ther 1990;4:687-94. Ellis SG, Cowley MJ, DiSciascio G, Deligonul U, Top01 EJ, Bulle TM, Vandormael MG. Determinants of 2-year outcome after coronary angioplasty in patients with multivessel disease on the basis of comprehensive preprocedural evaluation. Circulation 1991;83:1905-14. Kohli RS, DiSciascio G, Cowley MJ, Nath A, Goudreau E, Vetrovec GW. Coronary angioplasty in patients with severe left ventricular dysfunction. J Am Co11 Cardiol1990;16:807-11. Stevens T, Kahn JK, McCallister BD, Ligon RW, Spaude S, Rutherford BD, McConahay DR, Johnson WL, Giorgi LV, Shimshak TM, Hartzler GO. Safety and efficacy of percutaneous transluminal coronary angioplasty in patients with left ventricular dysfunction. Am J Cardiol 1991;68:313-19. Connor AR, Vlietstra RE, Schaff HV, Ilstrup DM, Orszulak
42.
43.
44.
45.
after
single-vesselPTCA
TA. Early and late results of coronary artery bypass after failed angioplasty. J Thorac Cardiovasc Surg 1988;96:191-7. Hwang MH, Siduh P, Pacold I, Johnson S, Scanlon PJ, Loeb HS. Progression of coronary artery disease after percutaneous transluminal coronary - angioulastv. __ _ AM HEART J 1988:115: 297-301. Bottner RK, Green CE, Ewels CJ, Recientes E, Patrissi GA, Kent KM. Recurrent ischemia more than 1 Year after successful percutaneous transluminal coronary angioplasty. Circulation 1989;80:1580-4. Califf RM, Tomabechi Y, Lee KL, Phillips H, Pryor DB, Harrell FE Jr, Harris PJ, Peter RH, Behar VS, Kong Y, Rosati RA. Outcome in one vessel coronary artery disease. Circulation 1983;67:283-90. Klein LW, Weintraub WS, Agarwal JB, Schneider RM, Seelaus PA, Katz RI, Helfant RH. Prognostic significance of severe narrowing of the proximal portion of the left anterior descending coronary artery. Am J Cardiol 1986;58:42-6.
Long-term efficacy of triple-vessel angioplasty in patients with severe three-vessel coronary artery disease Between May 1962 and December 1966, a total of 103 patients underwent angioplasty of all three major coronary arteries at a single institution. Angiographic success was achieved in 334 of 352 vessels (95%) and in 441 of 460 lesions (96%). No patients required urgent bypass surgery, and none died during the procedure; six had non-Q wave infarctions. The mean length of follow-up time was 49 + 15 months (range 26 to 107 months). There have been 11 deaths, and one patient has undergone cardiac transplantation. Thirty-six patients had a clinical recurrence; 30 had repeat angioplasty and five had bypass surgery. Another nine patients eventually had bypass surgery after the clinical recurrence. At 46 months actuarial event-free rates are myocardial infarction, 96%; bypass surgery, 66%; and death, 69%. Of 66 current survivors, 56 are in functional class 0 to I, 21 are in class II, and seven are in class Ill. (AM HEART J 1992;124:1169.)
Mark F. Warner, MD, German0 DiSciascio, MD, Ravinder S. Kohli, MD, George W. Vetrovec, MD, M. Nagui Sabri, MD, Evelyne Goudreau, MD, Kim M. Kelly, BSN, and Michael J. Cowley, MD Richmond, Vu.
Multivessel coronary angioplasty has been used with increasing frequency in the management of patients with coronary artery disease.rm7 Although patients with three-vessel coronary artery disease are usually
From the Division of Cardiology, Department of Medicine, Medical College of Virginia. Received for publication March 20, 1992; accepted May 4, 1992. Reprint requests: Mark F. Warner, MD, St. Francis Hospital and Medical Center, 114 Woodland St., Hartford, CT 06105. 4/l/40607
referred for bypass surgery, a subset of them may be amenable to complete revascularization by means of coronary angioplasty. Previous reports have indicated that clinical success can be achieved with triple-vessel angioplasty in selected patients with threevessel disease7T8; however, the long-term outcome in this subgroup of patients is still not well characterized. To assess the long-term results of coronary angioplasty of all three major vessels, in this study we analyze our experience with 103 consecutive patients during a mean follow-up period of 4 years. 1169
1170
Warner
et al.
Table I. Clinical characteristics triple-vessel angioplasty Clinical characteristics
Age (yr) Mean Range Sex Male Female LVEF Mean
Range Previous MI Recent (
37.
38.
39.
40.
41.
Long-term follow-up
5
and long-term outcome. J Am Co11 Cardiol1990;16:1097-1102. Burton JR, Haraphongse M, Hsu L, Kappagoda CT, Rossall RE, Schlaut B, Senaratne MPJ. Risk stratification after percutaneous transluminal coronary angioplasty. Cardiovasc Drug Ther 1990;4:687-94. Ellis SG, Cowley MJ, DiSciascio G, Deligonul U, Top01 EJ, Bulle TM, Vandormael MG. Determinants of 2-year outcome after coronary angioplasty in patients with multivessel disease on the basis of comprehensive preprocedural evaluation. Circulation 1991;83:1905-14. Kohli RS, DiSciascio G, Cowley MJ, Nath A, Goudreau E, Vetrovec GW. Coronary angioplasty in patients with severe left ventricular dysfunction. J Am Co11 Cardiol1990;16:807-11. Stevens T, Kahn JK, McCallister BD, Ligon RW, Spaude S, Rutherford BD, McConahay DR, Johnson WL, Giorgi LV, Shimshak TM, Hartzler GO. Safety and efficacy of percutaneous transluminal coronary angioplasty in patients with left ventricular dysfunction. Am J Cardiol 1991;68:313-19. Connor AR, Vlietstra RE, Schaff HV, Ilstrup DM, Orszulak
42.
43.
44.
45.
after
single-vesselPTCA
TA. Early and late results of coronary artery bypass after failed angioplasty. J Thorac Cardiovasc Surg 1988;96:191-7. Hwang MH, Siduh P, Pacold I, Johnson S, Scanlon PJ, Loeb HS. Progression of coronary artery disease after percutaneous transluminal coronary - angioulastv. __ _ AM HEART J 1988:115: 297-301. Bottner RK, Green CE, Ewels CJ, Recientes E, Patrissi GA, Kent KM. Recurrent ischemia more than 1 Year after successful percutaneous transluminal coronary angioplasty. Circulation 1989;80:1580-4. Califf RM, Tomabechi Y, Lee KL, Phillips H, Pryor DB, Harrell FE Jr, Harris PJ, Peter RH, Behar VS, Kong Y, Rosati RA. Outcome in one vessel coronary artery disease. Circulation 1983;67:283-90. Klein LW, Weintraub WS, Agarwal JB, Schneider RM, Seelaus PA, Katz RI, Helfant RH. Prognostic significance of severe narrowing of the proximal portion of the left anterior descending coronary artery. Am J Cardiol 1986;58:42-6.
Long-term efficacy of triple-vessel angioplasty in patients with severe three-vessel coronary artery disease Between May 1962 and December 1966, a total of 103 patients underwent angioplasty of all three major coronary arteries at a single institution. Angiographic success was achieved in 334 of 352 vessels (95%) and in 441 of 460 lesions (96%). No patients required urgent bypass surgery, and none died during the procedure; six had non-Q wave infarctions. The mean length of follow-up time was 49 + 15 months (range 26 to 107 months). There have been 11 deaths, and one patient has undergone cardiac transplantation. Thirty-six patients had a clinical recurrence; 30 had repeat angioplasty and five had bypass surgery. Another nine patients eventually had bypass surgery after the clinical recurrence. At 46 months actuarial event-free rates are myocardial infarction, 96%; bypass surgery, 66%; and death, 69%. Of 66 current survivors, 56 are in functional class 0 to I, 21 are in class II, and seven are in class Ill. (AM HEART J 1992;124:1169.)
Mark F. Warner, MD, German0 DiSciascio, MD, Ravinder S. Kohli, MD, George W. Vetrovec, MD, M. Nagui Sabri, MD, Evelyne Goudreau, MD, Kim M. Kelly, BSN, and Michael J. Cowley, MD Richmond, Vu.
Multivessel coronary angioplasty has been used with increasing frequency in the management of patients with coronary artery disease.rm7 Although patients with three-vessel coronary artery disease are usually
From the Division of Cardiology, Department of Medicine, Medical College of Virginia. Received for publication March 20, 1992; accepted May 4, 1992. Reprint requests: Mark F. Warner, MD, St. Francis Hospital and Medical Center, 114 Woodland St., Hartford, CT 06105. 4/l/40607
referred for bypass surgery, a subset of them may be amenable to complete revascularization by means of coronary angioplasty. Previous reports have indicated that clinical success can be achieved with triple-vessel angioplasty in selected patients with threevessel disease7T8; however, the long-term outcome in this subgroup of patients is still not well characterized. To assess the long-term results of coronary angioplasty of all three major vessels, in this study we analyze our experience with 103 consecutive patients during a mean follow-up period of 4 years. 1169
1170
Warner
et al.
Table I. Clinical characteristics triple-vessel angioplasty Clinical characteristics
Age (yr) Mean Range Sex Male Female LVEF Mean
Range Previous MI Recent (
