PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY FAILURES IN PATIENTS WITH MULTIVESSEL DISEASE - IS THERE AN INCREASED RISK

In recent years, there has been a nationwide trend toward performing p ercutaneous transluminal coronary angioplasty in patients with multive ssel coronary artery disease. The clinical course of 57 consecutive pa tients who required emergency first-time coronary artery bypass grafti ng operations were reviewed to assess for difference in outcome betwee n the 28 patients (49%) with single-vessel disease and the 29 patients (51%) with multivessel disease. The two groups were similar in preope rative characteristics except for a higher proportion of chronic obstr uctive pulmonary disease in the patients with multivessel disease (p = 0.03). Twice as many patients with multivessel disease were in shock (single-vessel disease = 4 [14%], multivessel disease = 8 [28%], p = n ot significant) en route to the operating room and significantly more patients with multivessel disease required on-going cardiopulmonary re suscitation (single-vessel disease = 0 [0%], multivessel disease = 5 [ 17%], p = 0.03). Significantly more coronary artery bypass grafts were placed in the patients with multivessel disease (single-vessel diseas e = 1.5 +/- 0.4 multivessel disease = 2.9 +/- 0.7, p < 0.01), which re quired longer aortic clamping time (p = 0.02) and cardiopulmonary bypa ss time (p < 0.01). There were seven postoperative deaths; all but one occurred in patients with multivessel disease (single-vessel disease = 1 [4%], multivessel disease = 6 [21%], p = 0.05). According to multi variate analysis, incremental risk factors of mortality were preoperat ive shock (p < 0.01), urgent or emergency percutaneous transluminal co ronary angioplasty (p = 0.06), and multivessel disease (p = 0.12). Des pite a similar incidence of myocardial infarction (single-vessel disea se = 8 [29%], multivessel disease = 12 [41%], p = not significant), pa tients with multivessel disease had a higher incidence of cardiac morb idity (single-vessel disease = 4 [14%], muItivessel disease = 11 [38%] , p = 0.04) and noncardiac morbidity (single-vessel disease = 4 [14%], multivessel disease = 12 [41%], p = 0.02). By multivariate analysis, incremental risk factors of morbidity were preoperative shock (p < 0.0 1), multivessel disease (p = 0.02), and ejection fraction < 50% (p = 0 .07). In the subset of patients with multivessel disease, preoperative shock, ejection fraction < 50 and an age of 60 years or greater were associated with higher morbidity and mortality, In conclusion, the ris k of percutaneous transluminal coronary angioplasty failure is conside rably higher in patients with muItivessel disease, In certain subsets of patients with multivessel disease, coronary artery bypass grafting would be a safer procedure when compared with percutaneous translumina l coronary angioplasty for initial myocardial revascularization.