Multivessel angioplasty:

and single-vessel coronary A comparative study

To determine the efficacy of multivessel coronary angioplasty, 569 consecutive patients undergoing multivessel angioplasty were compared with 569 age- and sex-matched control patients undergoing single-vessel angioplasty. Baseline variables were similar except for number of diseased vessels and greater left ventricular dysfunction in the multivessel group. Major in-hospital complication rates (death, 0% vs 0.5%; Q wave myocardial infarction, 0.5% vs 0.9%; emergency bypass surgery, 2.5% vs 3.2%) were similar for multivessel and single-vessel angioplasty. The 5-year actuarial survival rate was 93% for multivessel angioplasty and 92% for single-vessel angioplasty. Event-free survival was similar except that patients undergoing multivessel angioplasty had an 8% higher incidence of repeat coronary angioplasty in the first year of follow-up (p = 0.03). Multivessel coronary angioplasty can be performed with results comparable to those of single-vessel angioplasty with the exception of a higher incidence of repeat angioplasty. (AM HEART J 1992;124:9.)

,Jay Hollman, MD, Conrad Simpfendorfer, MD, Irving France, MD, Patrick Whitlow, MD, and Marlene Goormastic, MPH. Cleueland. Ohio

Multivessel coronary angioplasty is being used with increasing frequency as a modality of therapy for patients with multivessel disease, although questions remain regarding its safety and long-term efficacy. Early data suggested that multivessel angioplasty might be associated with a higher recurrence rate than that of single-vessel angioplasty.’ Late follow-up of the original patients of Gruentzig et al.” showed a higher mortality in patients with multivesse1 disease undergoing coronary angioplasty compared to patients with single-vessel disease. Gaul et al? suggested that the incidence of complications after acute occlusion was clearly higher in multivessel compared to single-vessel angioplasty. The purpose of this study was to review acute complications and long-term results in patients undergoing multivessel

angioplasty

compared

with an age- and sex-matched

control group undergoing single-vessel angioplasty. METHODS From .January 1981 to February 1988, a total of 595 patients underwent elective multivessel percutaneous transluminal coronary angioplast,y (PTCA) as a primary revasFrrm Dqxm~nents dation. Hweivrd Rt:print C’leveland 4/1/3736~

of (‘ardiology

tar publication requests: Conrad Clinic Foundation,

Nov.

and Riostatistics, 8, 1991;

Simpfendorfer, 9500 Euclid

accepted

Cleveland Dec.

Clinic

Fm~n-

30, 1991.

MD, Department Ave., Cleveland,

of Cardiology, OH 44195.5066.

cularization procedure. Twenty-six patients were excluded because they were undergoing angioplasty for acute myocardial infarction. The remaining 569 were matched by age and sex to 569 patients undergoing single-vessel angioplasty. Angioplasty was performed by standard technique, with patients pretreated with aspirin and calcium channel blockers. Definitions. Terms were defined as follows: Single-uesse1 disease, 250“; narrowing in one of the major epicardial coronary arteries (left anterior descending, circumflex coronary,orrightcoronaryartery); multivesseldisease, 250% narrowing in more than one major epicardial coronary artery; single-vessel PTCA, dilatation of only one major epicardial vessel; multivessel PTCA, dilatation of more than one major epicardial vessel. In-hospital complications were obtained from the Coronary Angioplasty Registry discharge forms. These data are gathered by a trained chart reviewer 2 to 3 months after the angioplasty procedure. Q wave myocardial infarction in this study is defined as the presence of a new Q wave on the discharge ECG. Follow-up data were obtained by either a mailed questionnaire or direct phone contact with the patient, immediate family, or personal physician. Statistical analysis. The mean levels for continuous factors were compared by means of Student’s i test. Categorical factors were tested for significant association by

meansof a chi-square test or Fisher’s exact test when the expected cell frequencies were too small. Cutter-Ederer estimates were used for survival and event-free survival curves. Comparisons between curves were done with a logrank test. Significance levels of 0.05 or less were considered to be statistically significant. 9

10

Hollman

et al.

kmertcan

JcliY lY82 Heart Journal

P=O.34

60 50

s 546 M 559 I 1

412 475

261 353

I 2

I 3

132 236

I 4

55 137

I 5

YEARS GROUP

-

Single

Fig. 1. Comparison of overall survival between multivessel group. S, Single-vessel group; M, multivessel group,

Table

I. Comparison

of angiographic

Variables

Extent of disease Single-vessel Double-vessel Triple-vessel Left main Left ventricular function Normal-mild Moderate-severe

Single-vessel FTCA

337

59"o

145

26L'C

80 7

14",' 1";

501 88”v 68

1‘2%

variables Multivessel PTCA

0 378 176 16 499 70

0°C 66', 31 ", 3'0 88°C 12',

RESULTS

The mean age was 59.4 f 10.2 for patients undergoing single-vessel and multivessel angioplasty. Sex distribution by study design was the same for each group: 144 women (25.3%) and 425 men. Average follow-up was longer for the group with single-vessel angioplasty, 44 +- 20 months, versus 36 t 17 months multivessel angioplasty for the group with (p = 0.0001). Extent of disease and left ventricular function are described in detail in Table I. As expected the group undergoing multivessel PTCA had more extensive disease, but 41% of the group undergoing single-vessel PTCA had multivessel disease. This was due to the inclusion of patients with ~50% stenosis; however, angioplasty was generally not performed in vessels with