Immediate and short-term benefit of multilesion coronary angioplasty: Influence of degree of revascularization

Abstract

The safety and short-term therapeutic benefit of multilesion percutaneous transluminal coronary angioplasty was assessed in 135 patients, 66 of whom had a minimum of 6 months of follow-up study. Primary success, defined as successful dilation of the most critical lesion or all lesions attempted without major in-hospital complications was obtained in 117 (87%) of the 135 patients. Cardiac complications associated with the procedure were uncommon; prolonged angina occurred in 5% and myocardial infarction in 3%; emergency coronary bypass surgery was performed in 4% of the patients. There were no deaths. Complete revascularization was achieved in 46% of the 117 patients with a primary success. Of the 66 patients eligible for 6 month follow-up, 80% had an uncomplicated course and required no further procedures. Clinical improvement by at least one angina functional class was observed in 90% of the patients. Cardiac events such as the need for a second revascularization procedure were significantly more common in patients who had incomplete versus complete revascularization (35 versus 9%; p = 0.018). Repeat coronary angiography performed an average of 5 months after angioplasty revealed restenosis in 18 of 22 symptomatic patients and 3 of 9 asymptomatic patients. Restenosis occurred at the site of a single dilation in 12 patients, at two sites in 8 patients and at three sites in 1 patient. Thus, multilesion coronary angioplasty is an important therapeutic option for selected patients with multivessel disease and can be performed with relatively low risk. Improvement in angina status can be expected even in patients who have incomplete revascularization.(ABSTRACT TRUNCATED AT 250 WORDS)

Desafios terapêuticos da insuficiência coronariana obstrutiva crônica

“…Estudos mais recentes [20][21][22][23][24][25][26] , envolvendo pacientes com doença multiarterial, que receberam tratamento randomizado para angioplastia ou cirurgia, demonstraram a mesma tendência dos estudos anteriores, ou seja, índice elevado de eventos ou cirurgia emergencial nos pacientes randomizados para tratamento através da angioplastia (tab. III).…”

“…Diferenças que estão relacionadas, especificamente, aos objetivos do estudo, ou seja, percentual de infarto, de morte e alívio dos sintomas. As diferenças observadas estão repetidas também nos portadores de doença multiarterial 16,[19][20][21][22] (tab. II).…”

Influence of Pre-PTCA Strategy and Initial PTCA Result in Patients With Multivessel Disease

“…These components, coupled with varying definitions and the distinction between anatomic versus functional CR, have led to numerous yet equivocal reports on the influence of CR on clinical outcome. [1][2][3][4]7 Among Ͼ2000 BARI patients treated with first-time PTCA during 1988 through 1991, we evaluated the relative contribution of pre-PTCA strategy (planned CR versus planned IR) and initial lesion outcome on clinical outcome. We considered a functional rather than anatomic definition of planned CR.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12] Early reports 1-3 suggest higher rates of CABG and angina in patients incompletely versus completely revascularized with PTCA, whereas others, including those with adjustment for differences in pretreatment clinical profiles, 4,7 report modest or no adverse effect associated with IR. Small patient cohorts and different analytic techniques and definitions of complete revascularization (CR) have contributed to the uncertainty.…”

Report of the Joint ISFC/WHO Task Force on Coronary Angioplasty. The International Society and Federation of Cardiology and the World Health Organization.

“…To standardize these definitions, the task force suggests that the widely accepted coronary anatomy nomenclature described by the Coronary Artery Surgery Study (CASS) group be followed.23 Multilesion PTCA refers to attempted dilatation of lesions in more than one segment of a major coronary artery, using the CASS nomenclature. Examples of multilesion PTCA in a single major coronary artery include 1) attempted dilatation of lesions in segments 13 (mid left anterior descending artery) and 15 (first diagonal artery), and 2) attempted dilatation of lesions in segments 19 (distal circumflex artery) and 20 …”