Abstract 2478: Long-Term Outcome After Coronary Angioplasty: a 15-Year Follow-up
Background: There are only a few reports on the determinants of long-term outcome after coronary angioplasty.
Aim : To assess the survival rate at 15 years after PTCA and the predictive factors of mortality.
Methods: The first 1000 PTCA procedures performed in our institution (1982–1989) were analyzed. The following baseline data were noticed : mean age was 56 y; tabacco: 69.9 %; insulin-treated diabetes: 1.1 %; chronic obstructive pulmonary disease (COPD): 6.6 %; renal failure: 0.9 %; recent myocardial infarction: 1.8 %; left ventricular dysfunction (EF < 50 %): 5.5 %; multivessel disease: 32.2 %. A total of 1084 segments were treated. The success per segment was 82.4 %. Multivessel PTCA was performed in 2.9 %. Procedural angiographic success was obtained in 80.8 %; complete failure occurred in 17.6 %, death in 0.8 %, Q-wave myocardial infarction in 2.3 %, emergency CABG was needed in 1.5 %.
Results : The survival status was assessed in all patients in 2005. After 15 years of follow-up, 299 patients were dead. The 5, 10, 15 y survival rates were respectively 91.5 %, 81.8 % and 68.6 %. In 48 %, death was of cardiovascular origin. The following baseline parameters were independent predictors of total mortality: insulin-treated diabetes (HR: 3.68), chronic renal failure (HR: 2.09); COPD (HR: 1.83); left ventricular dysfunction (HR: 1.39), multivessel disease (HR : 1.20); age (HR : 1.06). Incomplete revascularisation (measured by post-procedural angiographic score) was the only procedural variable predicting long term mortality (HR: 1.06). The angiographic results (partial or full success or complete failure) did not predict long-term outcome. Well established risk factors for arteriosclerosis - such as hypertension, obesity, dyslipidemia and tobacco - did not influence the long-term outcome.
Conclusions : The presence of non cardiac disease at the time of PTCA - such as diabetes, renal failure and COPD - as well as the extend of CAD and left ventricular dysfunction are predictors of the long-term mortality in low risk patients. Incomplete myocardial revascularisation - but not the immediate procedural failure - was the only procedural variable associated with a worse long-term outcome.