Long-term outcome of patients with incomplete vs complete revascularization after multivessel PTCA. A report from the NHLBI PTCA Registry.

BACKGROUND

Incomplete revascularization is frequently the goal as well as the final outcome in patients with multivessel coronary disease undergoing PTCA. However, the long-term impact of incomplete revascularization is not known and this common PTCA strategy deserves further scrutiny.

METHODS AND RESULTS

Complete revascularization was achieved in 132 of 757 patients with multivessel disease in the 1985-86 NHLBI PTCA Registry. Compared to patients in whom complete revascularization was achieved, patients with incomplete revascularization were older (P < 0.05), more likely to be females (P < 0.05) and to have recent myocardial infarction (P < 0.05), unstable angina (P < 0.001), and urgent or emergent PTCA (P < 0.001). Early death, Q wave myocardial infarction and CABG rates were higher in patients with incomplete than in those with complete revascularization [significantly different (P < 0.05) only for emergency and elective CABG]. At 9 years, nearly twice as many patients with incomplete revascularization experienced recurrent angina (19% vs 10% for patients with complete revascularization, P < 0.05). Patients with complete revascularization were more likely to undergo repeat PTCA than those with incomplete revascularization (40% vs 30%, P < 0.05). Patients with incomplete revascularization were more likely to undergo CABG than patients with complete revascularization (32% vs 14%, P < 0.001; adjusted risk 2.56, 95% CI 1.60, 4.10). Among patients with incomplete revascularization, those in whom PTCA was intended but not attempted had the highest early event rates and late CABG rates. Finally, the adjusted risk of dying, having a Q wave myocardial infarction, recurrent angina or repeat PTCA was not different at 9-year follow-up among patients with and without complete revascularization.

CONCLUSIONS

Complete revascularization achieved by PTCA reduces late occurrence of CABG, but not adjusted rates of death, Q wave myocardial infarction, recurrent angina, and repeat PTCA in patients with multivessel coronary disease. These data tend to support the PTCA strategy of incomplete revascularization in patients with multivessel disease when complete revascularization is not feasible or not planned before the procedure.