LATE OUTCOME OF MULTIVESSEL CORONARY-ARTERY DISEASE AFTER ANGIOPLASTYOR BYPASS-SURGERY

Background. Results from randomized trials to determine optimal treatm ent for patients with multivessel coronary disease are not yet availab le. Thus, the early and late outcomes of 191 PTCA and 221 CABG patient s done in 1985-86 were evaluated. Methods and Results. CABG patients s elected had more coronary risk factors and more severe coronary artery disease compared to PTCA patients. Comparison of the initial outcome showed that clinical success without major cardiovascular events was s imilar (93.7% for PTCA vs. 90.0% for CABG; p=n.s.). Five year followup was obtained in 99.0% of PTCA patients and 94.4% of CABG patients. In the PTCA group, 89.8% were alive, 4.8% had sustained an MI, and repea t revascularization was required in 46.8%. In the CABG group, 87.1% we re alive, 3.2% had had a MI, and 3.5% required repeat revascularizatio n. Statistical comparison demonstrated no difference between the group s in survival or late cardiac events, but rate of repeat revasculariza tion was significantly higher for PTCA patients (p<0.0001). Incomplete ness of revascularization (p<0.01) was independently associated with a n increased need for repeat revascularization in the PTCA group. In th e CABG group, depressed left ventricular function (p<0.001) and female sex (p<0.01) were associated with lower survival rates. An analysis o f cost per patient showed that the strategies were comparable. Conclus ions. PTCA and CABG in multivessel disease patients have similar early results and comparable rates of survival and late cardiac events. Sig nificantly more repeat revascularization is required in PTCA patients to maintain these results. The cost of each strategy appears to be com parable.