IMPACT OF POSTANGIOPLASTY RESTENOSIS ON COMPARISONS OF OUTCOME BETWEEN ANGIOPLASTY AND BYPASS-GRAFTING

Restenosis is a major limitation of percutaneous transluminal coronary angioplasty (PTCA). In this study, we assessed the impact of restenos is on PICA with reference to coronary angioplasty bypass grafting (CAB G). In the Coronary Angioplasty versus Bypass Revascularisation invest igation (CABRI) PTCA population, those who had restenosis were defined as those needing a second revascularization at a site revascularized at the initial procedure. The 1-year clinical outcome of the nonresten otic group (n = 437) wets compared with those who underwent CABG (n = 453). There was no difference in deaths. In the nanrestenotic PTCA gro up, the incidence of more infarctions was insignificant (relative risk [RR] 1.9, 95% confidence intervals [CI] 0.96 ta 3.75, p = 0.064), the re was a much greater need for repeat revascularization (RR 8.6, CI 5. 14 to 14.41, p < 0.0005), and patients had a poorer angina status (RR 1.46, CI 1.01 to 2.13, p = 0.046). Using 2 measures of coronary diseas e, the degree of pre- and postrevascularization disease was compared b etween groups. There were no differences in prerevascularization disea se. However, using either measure, residual postrevascularization dise ase was more frequent in the nanrestenotic PTCA group. Restenosis only partially accounts for the greater morbidity seen after PICA, compare d with CABG, in multivessel disease. The greater likelihood of residua l disease post-PICA may contribute to this greater morbidity. (C)1998 by Excerpta Medica, Inc.