CLINICAL AND ANGIOGRAPHIC FOLLOW-UP AFTER CORONARY ANGIOPLASTY IN PATIENTS WITH 2-VESSEL DISEASE - INFLUENCE OF COMPLETENESS AND ADEQUACY OF REVASCULARIZATION ON LONG-TERM OUTCOME

To assess the influence of the degree of revascularization on long-term results with angioplasty in multivessel disease, 151 consecutive patients with double-vessel disease and successful angioplasty in at least one vessel were prospectively followed up for a mean of 14 months (range 6 to 30 months) with clinical evaluation, an exercise stress test, and routine angiography. Patients were divided into three groups according to completeness and adequacy of revascularization: group 1-complete revascularization (no residual stenosis greater than or equal to 70%, 51 patients); group 2-incomplete but functionally adequate revascularization (residual stenosis greater than or equal to 70% in a vessel <2 mm in diameter or supplying akinetic or dyskinetic segments of the left ventricle, 56 patients); group 3-incomplete and inadequate revascularization (residual stenosis greater than or equal to 70% in a vessel greater than or equal to 2 mm in diameter supplying normal or hypokinetic segments, 45 patients). There were no late deaths; one myocardial infarction occurred in group 1 patients, three in group 2, and two in group 3 patients (p = NS). Recurrence of angina was lower in group 1 (13 of 51 or 26%) and group 2 (16 of 56 or 28%) compared with group 3 (23 of 45 or 51%, p < 0.01). A positive stress test for ischemia was present in 20 patients (39%) of group 1, in 30 (54%) of group 2, and in 26 patients (58%) of group 3. The restenosis rate per patient (49%, 36%, and 51%, respectively) and progression of coronary disease (10%, 7%, and 11%, respectively) were not statistically different in the three groups; however, among patients with restenosis or progression of coronary artery disease, those in group 1 were more often asymptomatic (16 of 27 or 59%) versus those in group 2 (7 of 23 or 30%, p < 0.05) or in group 3 (2 of 25 or 8% p < 0.001). A second revascularization procedure was more frequently performed in group 3 patients (53%) compared with group 1 (27%) and group 2 patients (29%) (p < 0.05). We conclude that: (1) long-term clinical results of angioplasty in patients with multivessel disease correlate with the degree of revascularization; (2) the distinction between incomplete-adequate and incomplete-inadequate revascularization is useful and separates patients with different outcomes; and (3) angiographic restenosis and coronary artery disease progression are more frequently asymptomatic in patients with complete versus incomplete revascularization.