Two- to three-year follow-up of patients with single-vessel coronary artery disease randomized to PTCA or medical therapy (results of a VA cooperative study)

Despite increasing use of percutaneous transluminal coronary angioplasty (P TCA) to treat stenotic coronary artery disease, there are relatively few pr ospective studies evaluating its long-term effectiveness. We prospectively randomized 212 stable patients with provocable myocardial ischemia and sing le-vessel subocclusive coronary disease to receive primary therapy with eit her PTCA or medical therapy. This report presents the clinical follow-up of these patients at a mean, after randomization, of 2.4 years for interview and 3.0 years for exercise testing. Of the 212 patients originally randomiz ed, 175 received an extended follow-up interview, and 132 underwent exercis e testing; 62% of patients in the PTCA group were angina free compared with 47% of patients in the medical group (p < 0.05). Furthermore, exercise dur ation as measured by treadmill testing was prolonged by 1.33 minutes over b aseline in the PTCA group, whereas it decreased by 0.28 minutes in the medi cal group (p < 0.04). Although the angina-free time on the treadmill was no t different (p = 0.50), fewer patients in the medical group developed angin a on the treadmill at 3 years than those in the PTCA group (p = 0.04). By 3 6 months, excluding the initial randomized PTCA, use of PTCA and use of cor onary artery bypass surgery were not different in the 2 treatment groups. T hese data indicate that some of the early benefits derived from PTCA in pat ients with single-vessel coronary artery disease are sustained, making it a n attractive therapeutic option for these patients. (C) 1998 by Excerpta Me dico, Inc.