Influence of Pre-PTCA strategy and initial PTCA result in patients with multivessel disease - The Bypass Angioplasty Revascularization Investigation (BARI)

Background-In PTCA patients with multivessel coronary artery disease, incom plete revascularization (IR) is the result of both pre-PTCA strategy and in itial lesion outcome. The unique contribution of these components on long-t erm patient outcome is uncertain. Methods and Results-From the Bypass Angioplasty Revascularization Investiga tion (BARI), 2047 patients who underwent first-time PTCA were evaluated. Be fore enrollment, all significant lesions were assessed by the PTCA operator for clinical importance and intention to dilate. Complete revascularizatio n (CR) was defined as successful dilatation of all clinically relevant lesi ons. Planned CR was indicated in 65% of all patients. More lesions were int ended for PTCA in these patients compared with those with planned IR (2.8 v ersus 2.1). Successful dilatation of all intended lesions occurred in 45% o f patients with planned CR versus 56% with planned IR (P<0.001). In multiva riable analysis, planned IR (versus planned CR), initial lesions attempted (not all versus all intended lesions attempted), and initial lesion outcome (not all versus all attempted lesions successful) were unrelated to 5-year risk of cardiac death or death/myocardial infarction but were all independ ently related to risk of CABG. Conclusions-Overall, a pre-PTCA strategy of IR in BARI-like patients appear s comparable to a strategy of CR except for a higher need for CABG. Whether the use of new devices may attenuate the elevated risk of CABG in patients with multivessel disease and planned IR remains to be determined.