Abstract 3520: Do the Patients with Multivessel Coronary Artery Disease Benefit from Completed Percutaneous Revascularization?-Long Term Follow-Up Study
Background: clinical importance of the completeness of revascularization in multivessel coronary artery disease (MVD) achieved with angioplasty is still a matter of debate.
Aim: To evaluate the impact of complete percutaneous revascularization on long-term prognosis in MVD pts.
Material and methods: 908 pts (83% male, aged 30–83years) with MVD treated with balloon angioplasty between 1988 and 1997 were included. Pts have been followed-up for 11(8–16) years. Complete revascularization (CR) was defined as successful (residual stenosis<50%) angioplasty of all significant lesions Incomplete revascularization (IR) was recognized in case of unsuccessful or not attempted angioplasty in any significant lesion Left ventricle(LV) dysfunction was defined as ejection fraction<40%. Information regarding cardiovascular events was obtained in 96% subjects. Analysis of variance, Kaplan-Meyer analysis and proportional hazard stepwise regression were processed.
Results: the CR was achieved in 284 pts. Pts with CR and IR did not differ as for age, gender, BMI and smoking. Patients with IR more frequently had previous myocardial infarction (65.9vs58.4%, p<0.05), family history of coronary artery disease (45.9vs8.6%, p<0.001), at least one coronary occlusion (47.4vs25.0 %, p<0.0001) and LV dysfunction (54.0vs9.9%, p<0.0001). The prevalence of hypertension was more common in CR-subgroup (50.3vs42.6%, p<0.05). The completeness of revascularization affected neither total (17.7 % in CR and 17.0% in IR-subgroup,p=ns) nor cardiovascular mortality (12.9vs12.4% respectively,p=ns,) as well as the prevalence of myocardial infarction (23.8vs24.0 %, respectively,p=ns,). Patients with IR required more re-PTCA (28.8 vs 17.2% , p<0.001) and hospitalizations during the follow-up period (49.8 vs 34.7%, p<0.0001). However, the independent predictors of long term mortality were LV dysfunction (HR 2.00, 95%CI 1.35–2.95; p<0.001) and age (HR 1.23 for every 10 years increment, 95%CI 1.03–1.44, p<0.05)
Conclusions: despite significantly different risk profile of patients with complete and incomplete revascularization, only the LV dysfunction and age were the independent predictors of long-term mortality in patients with MVD treated with angioplasty.