PREDICTORS OF LONG-TERM CARDIAC SURVIVAL IN PATIENTS WITH MULTIVESSEL CORONARY-ARTERY DISEASE UNDERGOING PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

The predictors of 5-year cardiac survival in patients with multivessel coronary artery disease (CAD) undergoing percutaneous transluminal coronary angioplasty (PTCA) were analyzed in a series of 637 consecutive patients. The average age was 59 +/- 11 years in 472 men and 165 women. Diabetes mellitus, previous myocardial infarction and unstable angina were presented in 119 (19%), 261 (41%) and 305 (47%) patients, respectively. Angiographically, 460 patients had 2-vessel and 177 patients had 3-vessel CAD. The left ventricular contraction score was greater-than-or-equal-to 12 in 55 patients. Angiographic success (< 50% residual stenosis) was achieved in 85% of the 1,343 narrowings and clinical success was obtained in 526 (83%) of the 637 patients. Complete revascularization was obtained in 177 (34%) of 526 successful patients. Procedure-related complications resulted in death in 9 patients (1.4%), in Q-wave myocardial infarction only in 6 patients (0.9%) and in emergency bypass surgery in 44 patients (6.9%) (of whom 10 had Q-wave myocardial infarction). Follow-up for greater-than-or-equal-to 1 year and up to 6 years after PTCA was obtained in 608 (95%) of the 637 patients. To determine the predictors of 5-year cardiac survival, 28 clinical, angiographic and procedural variables were analyzed by Cox proportional-hazards regression. The estimated 5-year survival after PTCA was 88 +/- 2% in successful patients and 77 +/- 5% in patients in whom PTCA was unsuccessful (p < 0.001). When clinical success was forced into the Cox regression, the left ventricular contraction score of greater-than-or-equal-to 12, diabetes mellitus and age greater-than-or-equal-to 65 years showed additional adverse effects on survival. When analysis was limited to 503 patients with clinical success and greater-than-or-equal-to 1 year complete follow-up, the only independent predictor of cardiac mortality was the left ventricular score of greater-than-or-equal-to 12. In conclusion, left ventricular function was the most important determinant of cardiac survival in patients with multivessel CAD undergoing PTCA, independent of the clinical success of the procedure. Advanced age and diabetes mellitus were associated with additional risk in the overall group, but not in the successfully treated group. In patients with multivessel CAD, 5-year survival after PTCA is excellent in the absence of these adverse prognostic factors.