PROSPECTIVE CASE-CONTROL COMPARISON OF PERCUTANEOUS TRANSLUMINAL CORONARY REVASCULARIZATION IN PATIENTS WITH MULTIVESSEL DISEASE TREATED IN1986-1987 VERSUS 1991 - IMPROVED IN-HOSPITAL AND 12-MONTH RESULTS

Objectives. This study sought to ascertain whether early and 12-month clinical outcomes after percutaneous coronary revascularization have i mproved between 1986-1987 and 1991. Background. Since the mid-1980s, w hen the results of percutaneous revascularization were considered to b e somewhat static, justifying large-scale clinical trials of percutane ous transluminal coronary angioplasty versus other modes of therapy, b alloon technology has improved, and several new percutaneous revascula rization techniques have become available. The clinical results of the current integrated approach to revascularization compared with those for coronary angioplasty alone in the late 1980s are not known. Method s. In this prospective case-control study, 200 consecutively treated p atients with multivessel disease in 1991 were studied prospectively an d compared with 400 consecutive patients from the same centers during 1986-1987. Patients from 1991 were matched with earlier patients on th e basis of four previously described prognostic determinants (left ven tricular ejection fraction, presence of unstable angina, diabetes and target lesion morphology score) and the treating institution and were assessed for treatment outcome (completeness of revascularization, pro cedural success and event-free survival [freedom from death, myocardia l infarction and further revascularization]). Results. The 1991 cohort of patients was older (mean [+/-SD] age 62 +/- 11 vs. 58 +/- 11 years , p < 0.001) and tended to have slightly worse left ventricular functi on (ejection fraction 56 +/- 10% vs. 58 +/- 11%, p = 0.009) than the 1 986-1987 cohort. Overall lesion morphology risk scores were similar. N ew devices (other than coronary angioplasty) were used in 26% of patie nts. The 1991 patient cohort had more frequent total revascularization (35% vs. 21%, p = 0.003), fewer emergency bypass operations (1.0% vs. 5.5%, p = 0.006) and an improved overall procedural success rate (90% vs. 84%, p = 0.04). In addition, at 12 months the event-free survival rate was superior in the 1991 cohort (73.3% vs. 63.6%, p = 0.02), alt hough there was no difference in infarct-free survival rate (94.6% vs. 93.2%, p = NS). Conclusions. Improved results with percutaneous revas cularization in 1991 have important implications for patient care and interpretation of ongoing randomized trials enrolling patients in the late 1980s and intending to compare standard coronary angioplasty with other forms of therapy.