TRIPLE VESSEL REVASCULARIZATION - CORONARY ANGIOPLASTY VERSUS CORONARY-ARTERY BYPASS-SURGERY - INITIAL RESULTS AND 5-YEAR FOLLOW-UP - COMPARATIVE COSTS AND LOSS OF WORKING DAYS AND WAGES

Objectives: The purpose of this study was to compare early and late ou tcomes in patients undergoing PTCA or CABG for triple vessel disease. Background: Although early results of PTCA/CABG randomized trials have recently become available, at present little data exists on long-term medical and socioeconomic effects of these treatment modalities in pa tients with triple vessel revascularization. Methods: During 1986-87, 76 patients undergoing triple vessel PTCA and 85 patients having tripl e vessel CABG were selected from a consecutive series of patients havi ng multivessel revascularization. Initial results and 5 year outcome, hospital stay and charges and out-of-work time were assessed from pros pectively collected data. Results: Clinical and morphological factors were similar in the PTCA and CABG groups. Hospital success and complic ations were also similar, except for higher mortality in the CABG coho rt (0 vs. 3.5%). Five year follow-up showed no differences in survival , nonfatal infarction and angina-free status; however, there was a dif ference in need for repeat revascularization (PTCA 55.4% vs. CABG 6.3% , p<0.001). Repeat PTCA accounted for 49% of the revascularization in the PTCA cohort. Crossovers were similar (PTCA --> CABG 6.8%; CABG --> PTCA 6.3%, pNS). Predictors of late death in the entire population we re female gender (p<0.0001), diabetes (p<0.05) and depressed LVEF (p<0 .05). The choice of revascularization procedure (PTCA vs. CABG) was no t an independent predictor of late death or MI. Analysis of initial ho spital charges showed a 2:1 advantage in favor of PTCA but this advant age was lost in late followup due to the need for repeat revasculariza tion in the PTCA group. However, the PTCA cohort lost fewer working da ys than CABG patients (3017 vs 5874 days) and therefore, lost less wag es ($7,022 vs. $14,685). Conclusions: The study shows that for selecte d triple vessel disease patients, PTCA and CABG results are comparable after 5 years, though repeat revascularization (mainly due to resteno sis) was necessary in the PTCA group to maintain these favorable resul ts. After 5 years, hospital charges are similar in the 2 groups, thoug h out-of-work time and lost wages were 2:1 in favor of PTCA.