IMPORTANCE OF DIABETES-MELLITUS AND SYSTEMIC HYPERTENSION RATHER THANCOMPLETENESS OF REVASCULARIZATION IN DETERMINING LONG-TERM OUTCOME AFTER CORONARY BALLOON ANGIOPLASTY (THE LDCMC REGISTRY)

The study examined the 10-year outcome in a cohort of 227 unselected, consecutive patients (age 58 +/- 10 years) undergoing coronary balloon angioplasty between 1984 and 1986 and followed in a single cardiac ce nter (Lady Davis Carmel Medical Center registry). In particular, we so ught to identify the relative importance of the systemic risk factors diabetes and hypertension and the extent of coronary disease as oppose d to procedure-related technical variables, the immediate success of t he procedure, or completeness of revascularization. By life-table anal ysis (99% follow-up), 94% of the patients were alive at 5 years, and 7 7% at 10 years after angioplasty. Ten-year survival was' reduced in pa tients with diabetes mellitus (59% vs 83%, p = 0.0008), in patients wi th previous myocardial infarction (68% vs 85%, p = 0.01), in patients with ejection fraction <50% (55% vs 82%, p = 0.005), and in patients w ith 3-vessel disease (58% vs 84% and 86% for 1- and 2-vessel disease, respectively, p = 0.04). Diabetes mellitus was the major independent p redictor of poor survival (adjusted odds ratio 3.1, 95% confidence int erval 1.55 to 6.19, p = 0.001). Survival at 10 years was identical in 199 patients in whom angioplasty was complete and in 25 in whom the ba lloon catheter did not cross the lesion, although bypass surgery was m ore frequent in the latter group (45% vs 21%, p = 0.001). Incomplete r evascularization did not predict poor survival (72% vs 79% with comple te angioplasty, p = NS). Event-free survival at 10 years for the whole group was 29%, and 49% of patients survived with no event other thana single repeat angioplasty procedure. Multivessel disease, hypertensio n, and diabetes mellitus were independent predictors of decreased even t-free survival, but incomplete revascularization was not. Thus, long- term outcome after coronary balloon angioplasty was related to diabete s mellitus, systemic hypertension, and extent of coronary disease, but not to the immediate success of the procedure or completeness of reva scularization. (C) 1998 by Excerpta Medico, Inc.