Complex transluminal angioplasty in multivessel coronary artery disease

ABSTRACTS

MONDAY, APRIL 26, 1992 PM PERCUTANEOUS TRANSLUMINAL 2:00-3:30

CORONARY

COMPLEX TRANSLUMINAL ANGIOPLASTY IN MULTIVESSEL CORONARY ARTERY DISEASE Simon Stertzer, MD, FACC; Gerald Dorros, MD, FACC; Richard Myler, MD, FACC; Michael Cowley, MD; FACC, David Williams, MD, FACC; Kenneth Kent, MD, FACC , Lenox Hill Hospital, New York, New York.

ANGIDPLASTY

NHLBI PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA) REGISTRY: FOUR YEARS EXPERIENCE Kenneth M. Kent, MD, Lamberto G. Bentivoglio, MD, Peter C. Block, MD, Michael J. Cowley, MD, Gerald Dorros, MD, Arthur J. Gosselin, MD, Andreas Gruentzig, MD, Richard K. Myler, MD, John Simpson, MD, Simon H. Stertzer, MD, David 0. Williams, MD, Martial G. Bourassa, MD, Sheryl F. Kelsey, Ph.D, Katherine M. Detre, MD, Suzanne Mullin, RN, Eugene Passamani, MD, NHLBI, Bethesda, Md.

Percutaneous transluminal coronary angioplasty (PTcA) is under evaluation in multivessel (MVD) coronary artery disease (CAD). In 368 patients in whom PTCA was performed, 152 (41%) had MVD. 46 patients (30%) of the MVD group had had previous coronary artery bypass graft surgery (CABG). The overall primary success rate in MVD patients was 73%. There was no significant difference in mortality thus far in patients undergoing PTCA with single vessel disease (SVD) (0.5%), or MVD (0.5%). However, in patients undergoing PTCA with MVD after previous CABG the mortality was significantly higher (2.1%). There were 120 attempts at two or more dilatations per patient in 58 cases. 95 primary successes were achieved in these 120 multiple dilatation attempts (79%). This compares favorably to PTCA in SVD. In the multiple dilatation group, there was no mortality, but 2 patients (1.6%) underwent emergency CABG. In all the MVD patients there were 18 recurrences (16%), l-36 months. Ten (17.2%) of the restenoses occurred in the 58 patients undergoing multiple PTCA’s during one procedure. Followup in the 58 patients having multiple dilatation revealed that 50 patients are clinically well (no angina 2-36 months) ; 8 are clinically well after elective CABG. It is concluded that multiple dilatation PTCA and PTCA in HVD are safe and feasible in carefully selected patients.

Data collected on 1898 patients (pts) undergoing PTCA during the past 4 years have been analyzed regarding effectiveness and safety of this new procedure in treatment of patients with coronary artery disease (CAD). 78% had single vessel disease (SVD), 62% were severely symptomatic (Class 3,4) with average duration of symptoms 3.3 months. Initially, there was a C in stenosis (>20%) in 64% with an average c of 50%. Of the variables &amined, stenosis site was the only determinant of auccessful PTCA: success=68% in left anterior descending and 44% in circumflex coronary arteries (pc.01).PTCA in pts with SVD was successful in 66%, vs 54% in pts with multivessel disease (MVD) (p